Biomedical subjects
Publications and source records attributed to M Cerný.
Hydrogen peroxide (H2O2) production in exhaled air was measured in ventilated preterm newborns at 5, 24 and 48 hours after delivery, using originally designed method of exhaled breath condensate (EBC) collection. H2O2 production in expired gas was 812+/-34 pmol/20 min during the first measurement and then declined to 389+/-21 at 24 hours and 259+/-26 pmol/20 min at 48 hours.
Acute lung injury occurs mostly in the very low birth weight and extremely low birth weight infants. The pathological process leading to acute lung injury includes immature and/or diseased lung that experienced oxidative stress, inflammation and mechanical insult with the bronchial, alveolar and capillary injuries and cell death. It may be the first step to the subsequent development of chronic lung disease of prematurity or bronchopulmonary dysplasia. The mechanisms of lung injury are extensively investigated in the experimental models and clinical studies, mostly performed on the adult patients. At present, the explanations of the mechanism(s) leading to lung tissue injury in tiny premature babies are just derived from these studies. Acute lung injury seems to be rather a syndrome than a well-defined nosological unit and is of multifactorial etiology. The purpose of this review is to discuss the main factors contributing to the development of acute lung injury in the very low or extremely low birth weight infants--lung immaturity, mechanical injury, oxidative stress and inflammation. Nevertheless, numerous other factors may influence the status of immature lung after delivery.
Treatment of 2-acetamido-3,4,6-tri-O-acetyl-2-deoxy-1-thio-beta-D-glucopyranose with 1,6-anhydro-3,4-dideoxy-2-O-p-toluenesulfonyl-beta-D-erythro-hex-3-enopyranose gave 2-acetamido-3,4,6-tri-O-acetyl-2-deoxy-beta-D-glucopyranosyl-(1-->4)-1,6-anhydro-2,3-dideoxy-4-thio-beta-D-erythro-hex-2-enopyranose in 86% yield. Its 1,6-anhydride bond was cleaved with methanol to give a mixture of methyl glycosides (alpha/beta approximately 5:1), from which the alpha anomer was separated by crystallization and converted into its 6-acetate, 6-methanesulfonate, or deacetylated to obtain the corresponding free methyl thiodisaccharide. The structure of the new compounds was confirmed by 1H and 13C NMR spectra.
2-Chloroethyl 1-thio-beta-D-galactopyranoside and the corresponding 1-thio-beta-D-glucopyranoside have been found to be suitable glycosylating agents for the preparation of different types of glycoconjugates. Glycosylation of bovine serum albumin and chymotrypsin were chosen as examples of an application of the described compounds. The glycosylating agents can modify not only amino groups, but also alkyl hydroxyl and aryl hydroxyl groups, as was shown in experiments with model water soluble and water insoluble polyacrylamide copolymers.
The multidisciplinary care of cleft defects in the Prague Department of Plastic Surgery has a long tradition. The authors describe the team care of patients including the timing of the surgery as well as the conservative therapy.
Between January 1992 and March 1994 in Klimentska Screening Centre 635 second trimester amniocenteses were performed because of the risk of a chromosomal aberration. 416 (66 per cent) procedures were recommended because of the mother's age over 35 years and 219 ones (34 per cent) because of a positive screening test. Maternal serum alpha-fetoprotein and human chorionic gonadotrophin were used as screening markers in most cases. Five trisomy 21 cases in the advanced age group were detected. Serum markers were assessed in three older mothers with an affected foetus after amniocentesis. All were ex post screen positive. Three trisomy 21 foetuses of mothers younger than 35 years were detected in the screen positive group. Recent advances in screening for Down's syndrome and other congenital defects are discussed.
In order to verify the type of heredity and to identify other genealogical characteristics in the Czech population, the authors examined 105 families with incidence of hypertrophic cardiomyopathy (HCM). The probands' siblings presented a 24-percent empiric risk of the disease; in male probands the risk for brothers was four times that for sisters, in female probands it was three times higher for sisters than brothers. Sex ratio of affected siblings was 20:4 in male and 3:14 in female probands. Disease risk for children was substantially higher in younger probands (under 30 yrs. of age: 40%, above 51 yrs.: 6.7%). Reproduction fitness was decreased in the whole group more so in women. Gene penetration was estimated using the "safe carriers" method, as 50 p.c. Anticipation and more severe course were recorded in all families with HCM incidence in more than two generations. The HCM heredity does not resemble that of the autosomal dominant type. The heterogeneity, phenocopy and sexual modulation could not be excluded. Genetic counselling and, possibly, DNA diagnostics would be necessary to elucidate the hereditary nature of hypertrophic cardiomyopathy.
The authors tested the possibility of assessment of fertile and infertile days during the menstrual cycle by investigating the crystallization of saliva by means of a minimicroscope PC 2000 IMPCON. They followed up for five months a total of 58 women where they assessed by a combination of at least three classical examination methods ovulatory and anovulatory cycles. They monitored a total of 120 cycles and examined 1649 specimens of saliva. Some women had to be eliminated on account of virosis during a flu epidemic (a total of 11 cycles). During the periovulatory period the authors recorded in ovulatory cycles the foreseen crystalline structures in saliva in 78.57%. In anovulatory cycles agreement between the expected character of the saliva specimen and anovulation was found in 84% of the examined cycles. In addition to structures suggesting fertile or infertile days, the authors identified also intermediary types. In the discussion the authors analyze various aspects as regards evaluation of the correlation between salivary and serum levels of gonadotropins and ovarian steroids. They evaluate physical and chemical changes of saliva and vaginal secretion and discuss the problem of crystallization of the saliva during the menstrual cycle. Based on their findings, when testing the minimicroscope PC 2000, they supplement the list of factors with influence the results of examinations. They consider PC 2000 a suitable modern equipment which extends the range of contraceptives and at the same time helps to assess the optimal time for conception in planned pregnancies.
The authors present values of plasma amino acid concentrations assessed on an automatic analyzer in a group of 12 mature neonates whose early and late post-partum adaptation and subsequent psychosomatic development followed-up to the age of 18 months was normal. The amino acids were assessed at the time of delivery, during the maximal weight loss of the infant after the third day and the last estimation was made before discharge from the maternity hospital when the body weight curves of all infants had a rising trend. None of the infants had neonatal jaundice and all were discharged fully breastfed.
ECMO is a therapeutic method which markedly improved the prognosis of premature or near term infants with severe cardiorespiratory insufficiency where conventional intensive care, incl. pulmonary ventilation and medicamentous support of the circulation did not help. It is method which needs the necessary technical equipment, perfect laboratory facilities and well trained teamwork. It is associated with risks which are not negligible, clearly defined indications as well as contraindications. The programme of ECMO, when introduced, should be regional and departments which use it should be in the area of large university hospitals. Despite the considerable costs associated with establishment of a therapeutic ECMO unit, it pays, as in the most threatened group of neonates it shortens the period these infants spend at the intensive care unit and reduces their mortality rate and severe forms of late postasphyctic morbidity.
In order to test the type of heredity and to assess further genealogical characteristics in our population the authors examined 105 families with hypertrophic cardiomyopathy. The families were subjected to clinical, electrocardiographic and echocardiographic examination of relatives (72% grade 1 relatives) as well as to a genealogical and psychological examination. For the proband's siblings the empirical risk of disease was 24%, in male probands it wts four times higher for brothers than sisters, in female probands it was three times higher in sisters. The sex ratio of six siblings in men was 20:4, in women 3:14. For children the risk was substantially higher in youner probands (under 30 years risk 40%, above 51 years 6.7%). The proband's parents were affected in 28%, fathers almost twice as frequently in male probands, and equally frequently in female probands. Fitness (reproduction fitness, f) was substantially reduced in the entire group, in isolated and familial cases and in different age groups, more in women than in men. The gene penetrance (assuming monofactorial heredity) was estimated by the method of definite carriers as 50%. Earlier manifestations (anticipation) and a more severe course of the disease was observed practically in all families with occurrence of the disease in more than 2 generations (influence of selection--sampling error). In our group the heredity in hypertrophic cardiomyopathies was not simple autosomal dominance, it was not possible to rule out heterogeny, phenocopy, sexual influence. On the other hand, the group was too small to make possible unequivocal conclusions and the data were not quite consistent with data in the literature. Genetic counselling, possibly DNA diagnosis, would be needed to elucidate heredity of this disease.
Prenatal factors influencing cleft lip (CL), cleft lip and palate (CLP) and isolated cleft palate (CP) may account for the development of the defect (aetiological factor) for a change in the degree or type of the defect (modifying factor), or for the death of the embryo (lethal factor). Each active factor appears to act in all three directions, all be it at different ratios. This is used for analysis of groups of cleft-effected individuals registered at the Department of Plastic Surgery, Prague, from the catchment area of Bohemia. In terms of cleft defect teratogenesis (aetiology, modification, lethality) a "protective influence" appears probable in female embryos, in blood group A (ABO system), in HLA antigens A9, A11, B35. An "embryotoxic influence" i.e., an increase in all the three influences is seen in male embryos, regional influences, in the B and AB blood groups, in HLA antigens B17, in primiparae, in multiple pregnancies, in older mothers and in cytomegalovirus infections. The Epstein-Barr virus seem to increase, in particular, CLP embryo lethality. The activity of the factors was rated by means of correlations between the cleft frequency in first-degree relatives and the frequency of the factor in six subgroups classified by the cleft defect subtypes, by means of interactions between two and more factors and by a study of the differences between male and female probands. A model of the threshold of CL and CP teratogenesis was proposed, a model in agreement with prenatal reciprocal equilibrium.
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In 1988-1989 the authors diagnosed and treated in the Paediatric Faculty Hospital in Prague 5 - Motol three neonates with a rare developmental anomaly--a cleft of the larynx, trachea and oesophagus. This rare anomaly was not yet published in our literature. Once a grade II cleft was observed, twice a grade III cleft. All neonates died. The authors discuss diagnostic and therapeutic problems associated with successful therapy. Early diagnosis, depending on the evaluation of the contrast examination of the deglutition pathways and endo scopic examination, are the basis for successful surgical treatment.
Sex diagnosis of skeletal remains represents one of the main problems in the forensic osteological practice. The purpose of the paper was to apply discriminant analysis as the method of its solution--in the set of measurements carried out on the hyoid bone. Classical procedure by R. A. Fisher yielded the set of linear discriminant functions applicable also in cases of injured bones, which is the relatively frequent situation. Information efficiency of the method proved to be quite satisfactory--in case of complete set of all six measurement level of misclassification should not reach over four per cent of the items to diagnose.
The Department of Plastic Surgery, Prague, provides comprehensive care to children and families where cleft lip and palate occur, which goes under the name of preventive family regimen. Apart from the treatment alone, this regimen is the concern of a number of specialists whose aim is to eliminate the parents' sense of "guilt", and to try, with the aid of the family, to create a situation which would improve the condition for the child's socialization. The geneticist is in charge of the prenatal preventive regimen which consists in the recommendation for the dated conception in an attempt to influence the baby's sex prior to conception, in eliminating potential internal and infectious (TORCH) etiological factors as well as potential teratogenic agents within the family. Gynecological care is aimed at uterine hypoplasia, atypia, gynaecological inflammation and hormonal deviations. Two months prior to conception and in the 1st trimester, it is recommended to keep to a diet rich in proteins, mineral substances, trace elements, vitamins and folic acid. The authors point to the potential risks of this method (impaired prenatal selection, increased fertility of risk families). At present, it is not possible to make an objective assessment of the results of the preventive pre-conception regimen due to the unrepresentative selection of the group under observation.
Seven women with endometriosis and three women with uterine myomas were treated for six months with tryptoreline (Decapeptyl, Decapeptyl Depot, Ferring). In six patients with endometriosis improvement was achieved according to the AFS classification and the finding on palpation and ultrasonic examination. In three patients with uterine myoma a reduction by 25-100% was recorded. Dysmenorrhoea and pain in the hypogastrium disappeared completely in all patients except one. The LH and FSH levels declined and E2 levels were similar as in the menopause. The menstrual cycle disappeared in the course of treatment and all women experienced flushes. Daily s. c. and monthly depot doses gave similar results. Four months after treatment the hormonal levels and the menstrual cycle were normal. Endometriosis disappeared twice, four times minor endometriotic nodes persisted, once a uterine myoma of half the size reappeared. Treatment with LH-RH agonists in endometriosis matches danazole treatment in uterine myomas it is suitable for special cases.
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