Biomedical subjects
Publications and source records attributed to M Wysocki.
A case of fulminant Cushing's syndrome due to an ectopic ACTH secretion in a patient with bilateral ovarian sex-cord stromal tumour is reported. Surgical resection of the ovaries as well as the inhibitors of steroid synthesis and cytostatics caused only transient improvement because the widespread neoplastic dissemination progressed very quickly.
To further delineate indications for noninvasive pressure support ventilation (NIPSV), we proposed this noninvasive technique as an alternative to endotracheal intubation in 17 consecutive patients with acute respiratory failure from various causes. Eight patients (47 percent) were successfully ventilated with NIPSV, while in 9 (53 percent), NIPSV failed. Gas exchange values before initiating NIPSV were different between the 2 groups: patients successfully ventilated with NIPSV had a higher PaCO2 (57 +/- 15 mm Hg vs 37 +/- 17 mm Hg; p = 0.01), a lower pH (7.33 +/- 0.03 vs 7.45 +/- 0.08; p = 0.02), and a lower alveolo-arterial oxygen pressure difference (P[A-a]O2) (144 +/- 46 mm Hg vs 265 +/- 18 mm Hg; p = 0.01), suggesting that CO2 retention without major hypoxemia is a better indication for NIPSV than severe hypoxemia alone. Acute respiratory failure occurring after extubation seemed to be a good indication for NIPSV, with an 83 percent rate of success. In both groups of patients, gas exchange improved after 1 h on NIPSV, but such values were not improved on the first day in patients who failed with NIPSV.
In the years 1975-1989 26 children were treated in hospital for acute leukaemia, who fell ill before completion of the second year of life. The analysis carried out similarly, as in the reports of other authors, showed worse results of treatment of leukaemia in this group of children.
A clinical analysis was carried out of the course of the disseminated form of the disease in 20 children aged from one month to 8 years (mean age 11 months). Unfavourable prognostic significance was confirmed of such factors as: child's age at the time of falling ill lower than two years, number of the involved organs and their dysfunction, and lacking reaction to treatment during the first three months of the disease.
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The components of blood flow resistance were investigated in 14 men with essential hypertension (diastolic blood pressure higher or equal to 100 mm Hg) before and after treatment with the dihydropyridine calcium antagonist-isradipine. Isradipine reduced intraarterial blood pressure by decreasing the total (placebo 5.1 U.mPa-1.s-1; isradipine 3.9 U.mPa-1.s-1), and renal (placebo 48.9 U.mPa-1.s-1, isradipine 35.4 U.mPa-1.s-1) vascular hindrance, the blood viscosity being unchanged. Arterial compliance was increased by isradipine (placebo 1.03 ml.mmHg-1; isradipine 1,25 ml.mmHg-1). The pressor response to adrenergic alpha stimulation with phenylephrine was decreased during treatment with the calcium antagonist. The compliance of the venous system was not changed by the treatment with isradipine. Haemorheological parameters were stable throughout the study but some changes in the correlations between the different rheological parameters were observed. The present study indicates that the antihypertensive effect of the dihydropyridine calcium antagonist isradipine was the result of functional modulation of the small and large arteries, the venous system and the flow properties of blood being unaffected.
Sixteen middle-aged men with primary hypertension were treated with the calcium antagonist isradipine over a 9-week period in a randomized, placebo-controlled, double-blind cross-over manner. At the end of the intervention period the urinary albumin excretion rate, systemic and renal haemodynamics, haemorheological properties of blood and plasma concentrations of atrial natriuretic peptide, noradrenaline and peripheral renin activity were determined. Treatment with isradipine resulted in a substantial reduction in blood pressure due to a reduction in peripheral resistance. The mean albumin excretion rate was not influenced by the isradipine treatment. In a multivariate analysis, changes in the urinary albumin excretion rate were only related to changes in blood pressure.
To help clarify the oxygen uptake/transport (VO2/TO2) relationship and because the oxygen extraction ratio (OER) and TO2 share no common variable such as cardiac index, we examined the changes in OER when TO2 was decreased in 12 patients with sepsis in whom a PEEP trial was performed. From zero end-expiratory pressure (ZEEP) to PEEP (12 +/- 3 cm H2O), a significant increase in OER from 30 +/- 10 percent to 38 +/- 12 percent (p less than 0.005) was observed, and individual percentage changes in OER were well correlated with individual percentage changes in TO2. The VO2 measured (VO2m) by respiratory gas analysis was unchanged, while VO2 calculated by the Fick equation (VO2f) decreased, suggesting a mathematical coupling between VO2f and TO2. Patients with hyperlactacidemia (n = 5) exhibited the same relationships between OER, VO2m, and TO2 as those without hyperlactacidemia. Our results suggest an adaptive response in the OER when TO2 is decreased in patients with established septic shock.
Allergic reactions of dramatic intensity were observed in 5 children treated with Teniposide (VM-26) for acute lymphoblastic leukaemia and histiocytosis X. In the further treatment this drug was replaced with epoxide, a cytostatic agent which is also a podophyllin derivative but in other chemical formulation. In none of these patients the allergic reaction returned.
Erythematous changes of the palms with associated oedema, blistering and desquamation were observed in two children during chemotherapy for acute lymphoblastic leukaemia, after methotrexate in doses of 1,000 mg/m2. These changes correspondent to those described in the literature as Burgdorf's reaction. In Poland it was never reported as yet.
Concentration of MTX was determined in the serum after the infusion of MTX in a dose of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2 to 24 children with ALL/NHL. The mean value of steady-state concentrations of MTX was two-fold greater after the infusion of a dose of 1.0 g/m2 and ten-fold greater after the infusion of a dose 5.0 g/m2 than at dose 0.5 g/m2. Great inpatient and interpatient variations of serum MTX concentrations were observed. Pharmacokinetic analysis of the data revealed biphasic model of the elimination. Statistically significant differences were found between the half-life MTX values (ti/2 alpha) in the first postinfusion day: the higher the dose, the shorter ti/2 was observed. The ti/2 of MTX during the second postinfusion day was significantly longer than that of the first day after infusion, but values for the higher doses were not significantly shorter than those for 0.5 g/m2. Systemic clearance (Cl) of MTX showed inpatient and interpatient variations of the values. However, no statistically significant difference was found between Cl values at doses of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2.
Concentrations of MTX were determined in the cerebrospinal fluid (csf) and serum after intravenous infusion of MTX at intermediate dose (0.5-1.0 g/m2) and at high dose (5.0 g/m2) to 20 children (33 infusions) with ALL/NHL. The cytotoxic concentrations of MTX in csf (> 1.0 microM/l) were reached in half of the cases after the infusion of MTX at intermediate dose and in all patients after the infusion of 5.0 g/m2. Great inpatient and interpatient variations of MTX concentrations in csf were observed. No statistically significant difference was found between mean systemic clearance of MTX in patients with MTXcsf concentrations > 1.0 microM/l and < 1.0 microM/l after infusion of MTX at intermediate dose.
A girl with acute myelogenous leukemia (AML) was treated with high dose arabinoside cytosine during consolidation. She developed jaundice twice after the completion of 3 rd and 4 th cycle of the drug. The jaundice was characterized by conjugated hyperbilirubinemia, elevated aminotransferases and alkaline phosphatase. The histologic study of the liver showed only infiltration by mononuclear cells in portal space and scarce bile pigment in some hepatocytes. In both cases jaundice receded spontaneously. Now the patient has been in complete remission for 36 months and subsequent liver function tests are normal.
Body fat distribution characterized by a high waist/hip ratio (WHR) has been described as a risk factor in the incidence of cardiovascular diseases and associated mortality. Hemorheological changes have been shown to accompany several risk factors. Gynoid and android obese women were compared in the present study with respect to hemorheological and metabolic variables and blood pressure. The android obese women had a significantly higher hematocrit and red blood cell count and showed higher blood viscosity at both high and low shear rates than women with the gynoid obesity type. Blood pressure was also higher in the android group. No significant differences were shown in concentration of cholesterol or triglycerides in serum nor in the microrheological properties of the red blood cells. The filterability index, which mirrors the number of rigid erythrocytes in the blood, was found to correlate with the plasma insulin concentration (r = 0.78, P less than 0.05) in the android but not in the gynoid obese women. It is concluded that the pathological changes in blood rheology observed in the android obese women may contribute to the high rate of cardiovascular events and associated mortality reported in this type of obesity.
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Evidence exists that volume expansion is associated with the appearance of a circulating sodium transport inhibitor. We have evaluated intra-arterial blood pressure (BP), central venous pressure (CVP), plasma renin activity (PRA), intraerythrocyte sodium content, erythrocyte sodium influx and rate constant of sodium efflux in 10 untreated primary hypertensive men (WHO stages I and II). The investigations were done during baseline conditions and after rapid intravenous infusion of 1 litre of saline (0.9% NaCl solution) over 15-20 min. Volume expansion caused an increase in CVP by 6.0 +/- 0.5 cmH2O (p less than 0.01), while BP only exhibited a slight increase. No significant changes in intraerythrocyte sodium content, sodium influx, sodium efflux rate constant or PRA were found after volume expansion compared to baseline. All patients with low normal PRA experienced a decrease in sodium efflux rate constant after volume expansion. We found a positive correlation between baseline PRA and change in sodium efflux rate constant after volume expansion (r = 0.62, p less than 0.05). At baseline the relationship between PRA and intraerythrocyte sodium content nearly reached statistical significance (r = 0.63, p = 0.054). These results may indicate that acute volume expansion influences the release of a circulating factor, modulating sodium transport in low-renin hypertension.
Seventeen middle-aged males with sustained essential hypertension (WHO stage II) and diastolic blood pressures (BP) exceeding 100 mm Hg during a placebo run-in period completed a trial to assess the hemodynamic effects of isradipine, a new dihydropyridine calcium antagonist. The study was double-blind and placebo-controlled with a crossover design. Brachial artery compliance was assessed as the ratio of stroke volumes and simultaneous pulse pressure. During therapy with isradipine (all patients received 7.5 mg b.i.d.), highly significant reductions in supine systolic BP [from 184 +/- 16 to 162 +/- 20 mm Hg (mean +/- S.D.)] and diastolic BP (from 96 +/- 8 to 83 +/- 8 mm Hg) were observed. Heart rate was unchanged (69 +/- 3 vs. 73 +/- 2 beats/min) during chronic therapy. Total peripheral resistance was significantly reduced (from 24.8 +/- 9 to 17.4 +/- 5 units) while cardiac output was unchanged (6.0 +/- 1.9 vs. 7.2 +/- 1.8 L/min). Stroke volume was unchanged (92 +/- 25 vs. 100 +/- 25 ml/beat), and a significant (p less than 0.05) increase in brachial artery compliance (from 1.05 +/- 0.25 to 1.26 +/- 0.35 ml/mm Hg) was observed.
Nosocomial infections affect about 5 p. 100 of surgical patients, and postoperative infections of the operative wounds or sites account for the major part of these infections. A knowledge of the potential organisms causing such infections and which vary according to the site and type of the surgical procedure is the most important guide to prophylaxis. Perioperative antimicrobial prophylaxis has made it possible to achieve a substantial reduction of surgical wound infection rates, and the basis for its use in each of the major surgical settings is reviewed.