Biomedical subjects

J Zapletalová

Publications and source records attributed to J Zapletalová.

At least 19 recordsLinked to original sources

PubMed2006

Continuous glucose monitoring -- a novel approach to the determination of the glycaemic index of foods (DEGIF 1) -- determination of the glycaemic index of foods by means of the CGMS.

UNLABELLED: The glycaemic index (GI) is a measure of the food power to raise plasma glucose (PG) concentration after a meal. For its determination, classical methods register the development of glucose concentration in capillary plasma or whole blood. The aim of this prospective open-label trial was to compare the GI of selected foods obtained by means of the Continuous Glucose Monitoring System (CGMS) (Minimed Medtronic, Northridge, USA) which has not been applied for this purpose until now, with the respective GI determined by a conventional method using the Glucometer Advance System (GAS) (Hypoguard, Woodbridge, United Kingdom), and to assess the advantages of each approach. METHODS: Portions of tested foods containing 50 g of carbohydrates were eaten for breakfast and for dinner after 10 and 4 h fast, respectively, by 20 healthy volunteers. Using GAS, PG-curves were constructed from 9 PG values at time 0, 15, 30, 45, 60, 75, 90, 105 and 120 min after the meal, and, using CGMS, from 25 values of interstitial fluid glucose concentration (ISFG) stored within 120 min in 5-minute intervals in CGMS memory. The GI was calculated (for GAS and CGMS separately) by dividing the incremental area under the curve for the tested food by the average area of 3 tests performed with the standard. Having excluded tests with missing glucose values, there remained 285 GAS- and 290 CGMS tests for further analysis. In each volunteer, each food was tested 3 times within one week so that 1 to 3 GI's were obtained and averaged. The GI for each tested food was calculated as the mean from the respective average GI's of 20 volunteers. The GI-variability was assessed according to the respective SD. The preference of GAS vs. CGMS in the persons tested was explored by means of a questionnaire. MS Excel and the statistical program SPSS v. 10.1 were used to analyze the data. RESULTS: The GI values (mean +/- SD) measured by GAS/CGMS were for dark chocolate 43.6 +/- 22.13 %/44.0 +/- 21.71 % (p > 0.01); for apple baby food 46.1 +/- 21.38 %/53.8 +/- 37.69 % (p > 0.01); for puffed rice squares 76.5 +/- 20.24 %/76.9 +/- 27.62 % (p > 0.01); for yogurt 43.2 +/- 20.17 %/37.7 +/- 21.55 % (p > 0.01). The GI's of dark chocolate, apple baby food and yogurt, determined by either method, were significantly lower than the GI of puffed rice squares (p < 0.01). CGMS was preferred by 12 of 20 volunteers (60 %). CONCLUSIONS: No significant difference could be seen between the GI's determined by conventional method (GAS) and by CGMS (p > 0.01). The method with CGMS is reliable and comfortable for both tested persons and investigators. Hence, it appears to become a sophisticated approach to determine the GI.

Adult↗

PubMed2006

[Measurement of acetabular polyethylene wear of total hip replacement, using a universal measuring microscope. Characteristics of measurements].

PURPOSE OF THE STUDY: The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthroplasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demographic data. MATERIAL AND METHODS: Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked. The results of measurements were evaluated by a series of statistical tests, including correlation and regression analyses and analysis of variance. RESULTS: High correlations were found among individual measurements made by each observer (r = 0.998; r = 0.973) as well as between the mean values obtained from the two observers (r = 0.996). The reliability of measurements was proved by a high correlation of the regression curve of each measurement with the "ideal" line. With two exceptions, the differences between paired measurements were not significant. CONCLUSIONS: Our method facilitates an in vitro measurement of polyethylene wear with considerable accuracy and high reliability.

Acetabulum↗

PubMed2006

[Molecular diagnostics for the detection of prosthetic joint infection].

PURPOSE OF THE STUDY: Ten years after inauguration of the molecular methods into the orthopaedic practice for diagnosing Prosthetic Joint Infection (PJI), this approach is still in the limelight of research and discussion. The aim of the current study was to determine the diagnostic power of our Polymerase Chain Reaction (PCR) protocol for preoperative detection of bacterial nucleic acid in the synovial joint fluid. MATERIAL AND METHODS: Synovial fluids obtained from thirty-five septic hip or knee arthroplasties and sixty-six aseptic controls were investigated by the conventional PCR technique. Two subgroups were established with regard to antibiotic administration before sample collection; with (n=13) and without (n=22) previous antibiotic exposition, respectively. All the surgeries were performed under the identical conditions with strictly established and fulfilled inclusion criteria. The study design applied was a prospective cohort trial. Primers targeting phylogenetically conserved regions of the bacterial gene were used to detect the bacterial 16SrRNA gene in the retrieved samples. If this was positive, a restriction endonuclease treatment of the amplified DNA was performed to reveal the PJI pathogen. Current guidelines were used to evaluate the test performance, including the confidence intervals. The concordance between the culture and PCR identification of PJI pathogens was estimated providing both of the relevant data were available. RESULTS: A qualitative analysis showed the following figures in the subgroup without previous antibiotic exposition: sensitivity (0.64), specificity (0.97), accuracy (0.89), positive predictive value (0.88), negative predictive value (0.89), likelihood ratio for positive result (21.0), and likelihood ratio for negative result (0.38). In the second subgroup the corresponding figures were as follows: 0.85, 0.97, 0.95, 0.85, 0.97, 27.9, and 0.16. The rate of concordance between the microbial and PCR findings was almost identical in both of the subgroups. DISCUSSION: There were large discrepancies in sensitivity and positive predictive values found in the published results. The earlier studies have had various methodological weaknesses, including a lack of strictly formulated inclusion criteria and control groups. In addition, there are differences among research centers in PCR laboratory procedures and specimen retrieval tactics which may potentially have an impact on PCR results. Low sensitivity and high specificity of our PCR technique may be explained by both the intrinsic (DNA extraction protocol, configuration of inner controls, choice of detection threshold, etc.) and extrinsic factors (in particular intra-operative retrieval of specimens). A hypothesis on the inadequacy of PCR techniques for PJI detection still remains to be excluded. CONCLUSION: Based on the current study, the positive results of our PCR technique may be perceived as a mild criterion from the point of power for PJI diagnosis support. However, its clinical utility should be significantly increased in cases with higher pretest probability of PJI, but negative cultures.

Adult↗

PubMed2005

[Molecular genetic study of causes of the Prader-Willi and Angelman syndrome].

BACKGROUND: Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are distinctive diseases with severe impairment of psychomotoric development and behaviour. Both syndromes are caused by the loss of paternal (PWS) or maternal (AS) gene expression of chromosomal region 15q11-13. The work reveals the various causes of this loss. The choice of the most suitable method for screening of the genome mutations in the patients suspected of PWS and AS is another purpose of the work. METHODS AND RESULTS: The methyl specific analysis (MS PCR) in locus SNRPN, short tandem repeat (STR) analysis and fluorescent in situ hybridization (FISH) were used. In the group of 55 patients tested for PWS and AS only maternal allele was present in 11 patients and only paternal allele was present in 1 patient in the locus SNRPN: 10 microdeletions 15q11-13, 1 UPD(15)mat and 1 UPD(15)pat. CONCLUSIONS: MS PCR seems to be the most profitable method for the first step of selection of PWS patients. In positive cases is inevitable to use also additional tests of molecular diagnosis to distinguish the particular mechanism leading to the disorders. In AS patients is also MSPCR recommended as the first step although it is necessary to exclude mutation in UBE3A gene in case of MS PCR negativity.

Adolescent↗

PubMed2005

[Cardiac abnormalities of lyme borreliosis].

The article summarizes basic characteristics of Lyme borreliosis, its incidence, epidemiology, pathogenesis and clinical image. Particular attention is given to the review of papers aimed at the cardiac abnormalities--the Lyme carditis. Though they are not very frequent, due to the variability of their clinical course and due to various forms, which are difficult to diagnose, they can represent a specific problem. Major part of the article is given to the authors' own experience with the dilated cardiomyopathy of the Borrelia origin and namely to the perspective study of the patients after the skin form of the disease erythema migrans, who were treated "lege artis" in the early phase of the disease with antibiotics. Authors were interested how many of those patients would develop later the cardiac abnormalities.

Cardiomyopathy, Dilated↗

PubMed2005

[Varus supracondylar osteotomy of the femur -- long-term results].

PURPOSE OF THE STUDY: Varus supracondylar osteotomy of the femur is the surgical procedure indicated in young patients with symptomatic unicompartmental gonarthrosis associated with a valgus knee deformity. The aim of the study was to evaluate long-term results and to draw attention to the most frequent mistakes in the indication and surgical technique. MATERIAL: In the period from 1985 to 1995, 35 knees in 33 patients were treated by varus supracondylar osteotomy of the femur in the Department of Orthopedics, Teaching Hospital, Faculty of Medicine, Palacký University in Olomouc. The technique of medial closing wedge osteotomy of the distal femur held with a 90 degrees plate was used. For post-operative immobilization, a brace was applied in most of the patients. METHODS: The information recorded was as follows: age, type of arthritis, follow-up period, preoperative tibio-femoral angle, postoperative tibio-femoral angle, range of motion before and after surgery, post-operative Knee Society scores, complications, number of osteotomies converted to total knee arthroplasty, and time between osteotomy and knee prosthesis implantation. The survival of osteotomy was evaluated by the Kaplan-Meier analysis for censored data. The change in parameters obtained before and after surgery was assessed by the one-sample t-test and non-parametric Wilcoxon test. RESULTS: All 35 knees were evaluated. The average Knee Society score at follow-up was 77 points (range, 61-95), the average functional knee score was 78 points (range, 61-95). The average range of motion increased from the pre-operative 112 degrees (range, 75-130 degrees ) to post-operative 115 degrees (range, 90-135). This difference was statistically significant (p = 0.032; t-test for paired samples; Wilcoxon test). The average follow-up was 14.7 years (range, 10-20 years). The most frequent complications were progression of medial compartment arthritis (8 knees), loss of correction (6 knees) and arthrofibrosis (5 knees). Osteosynthesis failed in two knees and, in two, superficial wound infection was recorded. Due to failure of osteotomy, six patients (17 %) subsequently underwent total knee replacement. The osteotomy survival rate was 95% at 18 years (CI, 16-19 years). DISCUSSION: The results of this study are based on long-term observation and can be compared with the studies by Mironneau et al. or Finkelstein et al. These and other authors have achieved better results in terms of score values, which can be explained by the following five factors: the follow-up in their studies was significantly shorter than in our study. At our department knee arthroplasty became a routine surgical technique as late as the early 1990s, and even after that some tendency continued to indicate bi- and tri-compartmental osteoarthritis for osteotomy. Also we operated on patients who were overweight and on those who were older than recommended for this procedure. CONCLUSIONS: The prerequisite for successful varus supracondylar osteotomy of the femur in unicompartmental gonarthrosis is that the patient is active, younger than 62 years and is not overweight. Early diagnosis followed by osteotomy, which prevents further progression of the disease, is also important. The detailed pre-operative planning and exact performance of the procedure are fundamental conditions. In the post-operative period it is necessary to observe the relevant regimen including rehabilitation therapy. When these conditions are fulfilled, osteotomy can markedly postpone the necessity of total knee arthroplasty.

Adult↗

PubMed2004

[Is osteolysis associated with a stable total hip replacement asymptomatic?].

PURPOSE OF THE STUDY: It has been reported that periprosthetic osteolysis in a stable cementless total hip prosthesis is often free from symptoms. The aim of this study is to check this assumption and provide details on the clinical presentation of this troublesome and worrying complication of hip arthroplasty. MATERIAL: Between March 1999 and June 2002, 76 hips in 72 patients underwent revision arthroplasty for periprosthetic osteolysis associated with stable ABG I prostheses. This patient group included 53 females and 19 males. The average age at the time of revision was 49 years (range, 32 to 63). The average time between the primary and revision surgery was 54.6 months (range, 23 to 85). The average cup size was 49.7 mm (range, 44 to 60), the modular 28-mm CoCr head was used in 69 hips, 28-mm ceramic head in six hips, and 22-mm CoCr head in one patient. METHODS: The following characteristics were recorded: gender, age, type of patient, height, weight, symptoms, diagnosis, ERS, CRP, Harris hip score, cup size, abduction angle and extent of bony defects. The data of symptomatic and asymptomatic patients were compared by parametric or non-parametric tests. RESULTS: Before revision, 61 hips (80%) were symptomatic. The patients complained of pain or signs of instability or both, and these complaints were taken as indications for revision surgery. The remaining 15 hips (20%) were asymptomatic. The average period from the primary surgery to the appearance of the first symptoms was 43 months (range, 5 to 80). The average Harris hip score before revision was 68 points (range, 37 to 90) and 82 points (range, 10 to 98) in the symptomatic and asymptomatic patients, respectively (p = 0.002). There were no other significant differences between these patients. DISCUSSION: The results of our study are in agreement with the findings of Hozack et al., but not with those of Maloney et al. and others who have reported that the progression of osteolysis developing in association with hip arthroplasty can be without symptoms. CONCLUSIONS: Osteolysis developing around a stable cementless hip prosthesis is generally symptomatic, with pain being the most frequent symptom. Even without a periprosthetic fracture, osteolysis may seriously impair the function of a joint and comfort of the patient. Since symptomatic patients are likely to see their attending physicians, it is emphasized that attention should also be paid to asymptomatic patients who have prostheses with unsuitable designs or pairings.

Adult↗

PubMed2004

Immunohistochemical detection of the hMLH1 and hMSH2 proteins in hereditary non-polyposis colon cancer and sporadic colon cancer.

Defects in DNA mismatch repair system are involved in carcinogenesis of sporadic and inherited human cancers. We assessed the feasibility of using immunohistochemistry to detect tumors with DNA mismatch repair deficiency. We analyzed 81 samples (74 colon cancers (CC), 1 colon dysplasia and 6 extracolonic cancers) for hMLH1 and hMSH2 protein expression, microsatellite instability (MSI) and/or mutational analysis. A meta-analysis of the published data on immunohistochemistry of hMLH1/hMSH2 proteins was performed. Sensitivity and specificity of the method was calculated. Twenty four of 29 tumors from hMLH1/hMSH2 mutation carriers and 10 of 13 sporadic high frequency MSI tumors lost one of the proteins. None of the 42 tumors with stable microsatellites or low frequency MSI lost the proteins. Based on literature review of 49 publications on colorectal cancer, hMLH1 immunohistochemistry was able to detect 136 of 154 tumors from hMLH1 germline mutation carriers (the sensitivity of 88.3% [95%CI, 85.8-90.8%]), hMSH2 immunohistochemistry detected 99 of 109 tumors from hMSH2 mutation carriers (the sensitivity of 90.8% [95%CI, 88.5-93.1%]), and hMLH1/hMSH2 immunohistochemistry identified 1262 of 1382 tumors with high-frequency microsatellite instability not correlated with mutational analysis (the sensitivity of 91.3% [95%CI, 90.4-92.2%]). The specificity of the method was 99.4% (95%CI, 99.2-99.6%). In conclusion, immunohistochemistry of hMLH1 and hMSH2 proteins is a useful method to predict the presence of mismatch repair deficiency, although its sensitivity is lower than that of MSI analysis.

Adaptor Proteins, Signal Transducing↗

PubMed2004

[Diabetic gangrene as the prime manifestation of diabetes mellitus].

The diabetic foot syndrome is one of the most relevant complications of the diabetes mellitus and it represents a frequent reason for the hospitalisation of diabetic patients. The timely and complex treatment is need for stalling off or averting the surgical solution. Presented case report describes the patient with diabetic foot syndrome, that is exceptional by the late intercepting in the over wide phase of affection with all organ complications.

Diabetes Mellitus, Type 1↗

PubMed2004

[Validity of bone scintigraphy for the diagnosis of periprosthetic complications in hydroxyapatite-coated total hip arthroplasty].

PURPOSE OF THE STUDY: To evaluate the efficacy and usefulness of 99Tc-MDP bone scans for the diagnosis of complications associated with hydroxyapatite- coated total hip prostheses. MATERIAL AND METHODS: 99Tc-MDP bone scans of 42 hips were taken before revision surgery in 41 patients with ABG 1 prostheses. Of these, 26 patients (27 hips) were included in our study on the basis of the following criteria: at least 23 months between the index surgery and scintigraphic examination and the availability of good quality bone scans. The average patients' age at the time of index and revision operations was 45.3 years (range, 32-57; SD, 6.02) and 50.2 years (36-61; SD, 6.01), respectively. The average time between the index surgery and bone scintigraphy was 50.3 months (23-84; SD, 15.9). Two experienced specialists in nuclear medicine, who were unaware of any clinical conclusions, participated in the study. RESULTS: Pre- and intra-operative findings showed aseptic loosening in three cups (3/27, 11 %) and one stem (1/27, 4 %). Four hips were suspected to have an infection on the basis of the positive results of intra-operative culture. In the diagnosis of aseptic loosening, sensitivity, specificity, accuracy, and positive and negative predictive values of bone scintigraphy were 100 %, 57 %, 62 %, 23 %, and 100 %, respectively, for the ABG I cup and 100 %, 52 %, 54 %, 8 %, and 100 %, respectively, for the ABG I stem. These characteristics were 67 %, 96 %, 93 %, 67 %, and 96 %, respectively, for the ABG I cup, when plain X-ray was used for evaluation of aseptic loosening. Specificity, accuracy and negative predictive value of plain X-ray for ABG I stem aseptic loosening were 100 %, 96 %, and 96 %. Bone scintigraphy gave one false positive result of sepsis; on the other hand, none of the four hips with positive intraoperative culture was diagnosed as septic. DISCUSSION: The fact that 99Tc-MDP bone scintigraphy as a method of diagnosing periprosthetic complications has a high sensitivity and a relatively low specificity has often been discussed in the literature. Currently, there are only a few studies on bone scintigraphy investigations of hydroxyapatite-coated prostheses. Some authors report that a slight increase in peri-prosthetic radionuclide activity may persist for up to 8 years which can explain the problematic accuracy of the technique. CONCLUSIONS: 99Tc-MDP bone scintigraphy is an intermediate useful tool for detecting complications of total hip arthroplasty with hydroxyapatite- coating. A negative bone scan almost always suggested the absence of aseptic loosening. However, the value of a positive result was regarded as controversial for the diagnosis of both aseptic and septic complications.

Adult↗

PubMed2003

[Severing perforators in advanced stages of chronic venous insufficiency].

OBJECTIVE: To evaluate the importance of anastomozing veins in the development of chronic venous insufficiency (CVI). METHOD: Perspective analysis of a group of 82 extremities where the perforators were severed by the endoscopic or open method. RESULTS: Surgery of the perforators was associated with a decline of the total number of perforators detectable on DUS, with a marked reduction of extremities with insufficient perforators and improved total CEAP score. In 98% extremities at the same time surgery of the epifascial venous system was performed. CONCLUSIONS: The role of perforators in the development of CVI is not unequivocal and its assessment is more difficult due to concurrent operations of the epifascial system. Dissection of the perforators is indicated in cca one tenth of patients with CVI.

Adult↗

PubMed2003

[Early failure of the polyethylene liner in the ABG I total hip prosthesis].

PURPOSE OF THE STUDY: The polyethylene liner has appeared to be a weak point in total hip arthroplasty. An early wear-through or a fracture of the polyethylene liner have been referred to as a catastrophic failure. The aim of the present study is to report our experience with this rare complication in ABG I hip prostheses. MATERIAL: Between September 1994 and January 2000 a total of 506 ABG I prostheses were implanted at our clinic. Due to wear-related complications, revision arthroplasty had to be performed in 90 hips in 23 male and 63 female patients by January 2002. Extensive titanium metallosis associated with polyethylene failure was found in 11 hips of 11 female patients. The remaining 56 hips of 52 female patients served as a control group. METHODS: The characteristics recorded in every patient's included age, type of patient, sex, height, weight, ESR, CRP, diagnosis, Harris hip score before revision, cup size, abduction angle of the cup, time between the primary and revision surgery and implant stability. Student's t-test, the Mann-Whitney U-test and Pearson's chi 2 test were used to evaluate the results. RESULTS: The complete failure of ABG I prostheses occurred in 2.17% of the replaced hips (11/506). A fracture or complete wear-through were the causes of failure in three (3/11, 27%) and eight (8/11, 73%) hips, respectively. The average cup size in hips without metallosis was 48.9 mm (range, 44-58; SD, 3.1) and that in hips with metallosis was 46.5 mm (range, 46-48; SD, 0.9). This difference was highly significant (t-test, p = 0.00002; U-test, p = 0.014). In the hips with metallosis, the average thickness of the polyethylene liner was 5.17 mm (range, 4.9-5.9; SD, 0.45) and the Harris hip scores before revision were significantly lower than in the hips without metallosis (59 versus 70.3 points; t-test, p = 0.023; U-test, p = 0.044). There were no other significant differences between the hips with early catastrophic failure of the polyethylene liner and those without it. DISCUSSION: Several studies have shown an indirect relationship between polyethylene thickness and its wear. Berry et al. reported catastrophic failure in hip prostheses with a polyethylene thickness of less than 5 mm; in our study, the three failed polyethylene liners were 5.9 mm in thickness. CONCLUSIONS: This is the first report on a wear-through of the polyethylene liner in ABG I cups. It is suggested that a thin polyethylene liner, design characteristics and probably also poor polyethylene quality are crucial factors responsible for rapid wear in ABG I cup. The highest risk is associated with the combination of a 46 mm cup and a 28 mm head. Patients who have prostheses of this size should be checked up more frequently.

Adult↗

PubMed2002

[Importance of determination of serum beta-2-microglobulin levels in patients with Hodgkin's lymphoma].

The authors evaluated retrospectively in a group of 69 adult patients with Hodgkin's lymphoma the relationship between the beta-2-microglobulin serum level, basic demographic parameters (age, sex) and factors characterizing the extent (stage III and IV, "bulk" or mediastinal mass, number of affected areas of lymph nodes) and activity of the tumour (presence of B-symptoms, red cell sedimentation rate, haemoglobin, albumin and lactate dehydrogenase level, number of leucocytes and lymphocytes). They analyzed also the possible prognostic impact of beta-2-microglobulin on the therapeutic response risk of relapse and patient's survival. Methods of univariant statistical analysis confirmed the correlation of beta-2-microglobulin level with all investigated metric parameters of patients (advanced age, number of affected nodes, red cell sedimentation rate and lactate dehydrogenase level, lower albumin, haemoglobin level, numbers of leucocytes and lymphocytes). In multivariant analysis however the only independent metric markers significantly associated with an elevated protein level were more advanced age of the patients (P = 0.0002) and a lower number of leucocytes (P = 0.05). The values of beta-2-microglobulin was not influenced by the extent of the tumour (stage III and IV, "bulk" or mediastinal mass, higher number of affected areas of lymph nodes). Significantly more frequently elevated protein values were recorded in patients with manifestations of B symptoms associated with the diagnosis (P = 0.0003). Multivariant analysis did not prove the importance of the serum level of beta-2-microglobulin as a prognostic factor in the sense of predicted remission, development of a relapse or death in conjunction with progression of Hodgkin's lymphoma.

Adolescent↗

PubMed2002

[Therapeutic effectiveness of cladribine and cellular immunodeficiency--related effects in hairy-cell leukemia?].

The high therapeutic efficiency of lymphotoxic purine analogues, pentostatin and cladribine in hairy cell leukaemia which express the antigen CD25 (alpha chain interleukin-2 receptor) suggests the hypothesis whether protracted cellular immunodeficiency after treatment does not represent an important mechanism of control of this specific lymphoproliferation. The authors analyzed a group of 45 patients with CD25-positive hairy cell leukaemia treated with cladribine. In addition to the therapeutic response they evaluated also the state of cellular immunity during the subsequent months and years following cladribine administration. The regression lines of the development of different sub-populations CD4, CD8 and CD56-positive cells, interleukin-2 and its soluble receptor were evaluated separately in patients with persistent remission and patients with growth of the tumourous mass. Although this retrospective analysis provides only limited information we can deduce from it a long-term decline of CD4 lymphocytes correlating with the relatively low incidence of clinical progression of hairy cell leukaemias. The results of this clinical observation are consistent with some reported clinical and experimental observations.

Adult↗

PubMed2002

Expression of c-erbB-2 in node negative breast cancer does not correlate with estrogen receptor status, predictors of hormone responsiveness, or PCNA expression.

The aim of this study was to analyse the relationships between the expression of c-erbB-2, estrogen receptor (ER), progesterone receptor (PR), Bcl-2 and PCNA in node negative breast cancer. Expression of these markers was determined by HercepTest, by immunohistochemistry and quantified by morphometry in the group of 125 selected breast carcinoma patients with broad spectrum of histological types and grades. Multivariate statistical analysis revealed only relationships between ER/PR, ER/Bcl-2, ER/grade and ER/age. There was not found any significant relationship between c-erbB-2 expression and any other immunohistochemical marker, apocrine metaplasia, histological type or patient characteristics. The same result was found in complete group of tumors as well as in individual groups divided according to histological type. These results indicate that in node negative breast tumors, c-erbB-2 expression does not correlate inversely with hormone receptor status and hormone responsiveness like previously reported metastasising breast cancer and that the prognostic significance of c-erbB-2 expression in these tumors is not clear.

Adult↗

PubMed2002

[Analysis of specific sequences in female patients with Turner syndrome--initial study].

BACKGROUND: DNA sequences from chromosome Y can cause gonadoblastoma development in patients with Turner syndrome (TS). Estimated risk is about 30%. The aim of the study is detection of Y-sequences of DNA level, calculation of mosaicism and its cytogenetic location. Clinical result of the study is the recommendation to gonadectomy of proved positive patients. METHODS AND RESULTS: Samples from 110 patients were collected. The PCR method and analysis of products on agarose gel was compared with analysis of DNA fragments from quantitative fluorescent (QF) PCR on capillary electrophoresis. The loci DYZ3, AMGX/Y and SRY were used for detection. The method QF PCR was effected for DYZ3 and AMGX/Y loci. The positive cases were examined by FISH method. Five (4.5%) and 3 (2.7%) positive cases were detected in DYZ3 and SRY resp. loci by electrophoresis on agarose gel. Seventeen (15.5%) and 7 (6.4%) positive cases were detected in DYZ3 and AMGX/Y resp. by capillary electrophoresis. The estimated mosaicism ranged from 1:5 to 1:100,000. CONCLUSIONS: QG PCR is the most sensitive method for diagnostics of Y-sequences. Simultaneously the incidence of Y-positive cells can be estimated. The positive cases with marker in karyotype were confirmed by FISH.

Adolescent↗

PubMed2001

Borrelia infection as a cause of carditis (a long-term study).

BACKGROUND: Although the frequency of Lyme carditis is not high, it is one of the most challenging conditions in terms of diagnosis. No long-term studies that would help expand our body of knowledge concerning the circumstances of its development and the natural course of this form of Lyme borreliosis (LB), the most widespread anthropozoonosis in Central Europe, have been reported to date. AIM: The authors sought to describe and assess the consequences of a less common form of Lyme carditis (LC). An assessment of the following aspects was made: a) the forms, natural history and sequelae of the less common clinical appearances of LC, b) the role of antibiotic therapy with reference to the late manifestations of LB. METHODS: Three patients were selected from a group of 60 consecutive patients with demonstrated LC during a follow-up period from 1987 to 2000. Patient no. 1 was being followed for myocarditis with frequent ventricular extrasystoles, patient no. 2 for pericarditis, and patient no. 3 for dilated cardiomyopathy as a late manifestation of LB. In addition to routine examination at entry, the patients were subjected to a standard 12-lead ECG, continuous 24-hour Holter ECG monitoring, exercise testing (bicycle ergometry), investigations of antibodies using ELISA and Western blot, investigation of thyroid (T3, T4, TSH tests) and mineral levels. RESULTS: The study showed no significant correlation between the clinical course and levels of specific antibodies. It confirmed the concept that inadequate or no therapy with antibiotics in the initial stage of the disease has a significant effect on the development of late sequelae. CONCLUSION: Based on the long-term treatment of three patients with less common, yet clinically urgent findings, the authors conclude that even a relatively serious clinical course is associated with no major limitations for affected individuals after an interval of several years.

Adult↗

PubMed2001

IGF-I resistance and Turner's syndrome.

The pathogenesis of growth failure in Turner's syndrome is not clear but might be attributed to a decreased sensitivity to insulin-like growth factor-I (IGF-I) in distinct cell lines or to its reduced autocrine/paracrine action. Growth hormone (GH) therapy leads to increments in IGF-I levels and to growth acceleration. In order to evaluate the pattern of overcoming IGF-I resistance through childhood and adolescence, we measured IGF-I in 78 girls with Turner's syndrome aged 4.6-18.3 years on 160 occasions without or during GH (1 IU/kg/week [0.33 mg/kg/week]) or GH+estradiol (E2) therapy and compared them with local IGF-I standards. In untreated patients, IGF-I levels were low normal (-0.71+/-0.18 SDS, mean +/- SEM). In both GH or GH+E2 treated girls, circulating IGF-I levels were persistently supraphysiological (GH only: +3.61+/-0.23 SDS; GH + estradiol: +3.18+/-0.31 SDS). The age-dependent pattern of IGF-I secretion was conserved but the pubertal increase occurred earlier. The highest standardized IGF-I levels were observed at age 8.5-9.4 years (+6.62+/-1.00 SDS) and 9.5-10.4 years (+5.61+/-1.03 SDS). GH+E2 substitution had no additional effect on circulating IGF-I. We conclude that high IGF-I levels are needed to overcome the IGF-resistance in Turner's syndrome. They reflect the action of GH therapy but not of estrogens. The earlier pubertal increase of IGF-I might be caused by exaggerated adrenal androgens.

Adolescent↗