Biomedical subjects

Michał Nowicki

Publications and source records attributed to Michał Nowicki.

At least 37 records · Page 2Linked to original sources

PubMed2004

[Oxidative potential of neutrophils in cyclosporine A treated children with idiopathic nephrotic syndrome].

UNLABELLED: Cyclosporine A (CsA) is a potent immunosuppressant introduced to the treatment of idiopathic nephrotic syndrome (INS) in children. Besides beneficial effects on the clinical course of the disease, this drug may also influence the function of first line defence cells. The aim of the study was to assess the granulocyte generation of reactive oxygen intermediates (ROI) in children suffering from idiopathic nephrotic syndrome treated with cyclosporine A. MATERIAL AND METHODS: The study group consisted of 10 children (aged 4-18 yrs.) in at least 2 month-long remission of steroid-dependent INS treated with CsA (group A), 16 children in long-term remission (at least 18 months without treatment) of INS (group B). Twelve healthy age-matched children (group C) constituted control group. ROI generation was measured by the luminol-dependent chemiluminescence of whole blood using MLX Microtiter Plate Luminometer, Dynex. The following parameters were evaluated: spontaneous chemiluminescence, chemiluminescence induced by formyl-Met-Leu-Phe (fMLP), opsonized zymosan (OZ) and phorbol acetate (PMA). RESULTS: The primary results were corrected according to the absolute number of neutrophils and hemoglobin concentration. Final results were presented as relative luminescence units RLUmax (Relative Light Units Max). In children treated with CsA we found significantly increased spontaneous, fLMP and OZ stimulated chemiluminescence activity compared to patients from group C. Chemiluminescence tests conducted in the long-term remission of INS gave similar results with respect to neutrophil reactivity. CONCLUSION. The neutrophil function measured by spontaneous and receptor-dependent oxidative burst in children with either cyclosporine-induced or long-term treatment-free remission seems to be upregulated. The potential clinical implications of these observations remain to be established.

Adolescent↗

PubMed2003

Detection of substance P and its mRNA in human blast cells in childhood lymphoblastic leukaemia using immunocytochemistry and in situ hybridisation.

The study focused on determining the expression of substance P (SP) in neoplastic cells of childhood acute lymphoblastic leukaemia (ALL) at the levels of its mRNA and the protein production. The study group comprised 44 children treated for ALL in the Department of Paediatric Haematology and Oncology, Karol Marcinkowski University of Medical Sciences in Poznań, in the years 1999-2001. Bone marrow smears were obtained by needle biopsy. Expression of SP was examined by immunocytochemistry with specific antibody against human SP and by in situ hybridisation with anti-mRNA 5'-biotinylated probe. The results of the study demonstrated that SP could be detected in the cytoplasm of lymphoblasts (mean percentage of 81.8% for immunocytochemical and 84.5% for in situ hybridisation technique) in leukaemias of the common and T-cell types. SP was absent from blasts in B-cell leukaemia and from normal haematopoietic, cells in children of the control group. The results show that lymphoblasts of common and T-cell origin acquire the capability to synthesise SP after their neoplastic transformation in childhood acute leukaemia. SP may be involved in auto- and paracrine mechanisms capable of inducing hyperplasia of the neoplastic cells.

Adolescent↗

PubMed2003

[Increased thrombin-genesis in cyclosporine A-treated idiopathic nephrotic syndrome in children].

Cyclosporine A (CsA) has been accepted as one of the most efficient therapies of idiopathic nephrotic syndrome (INS) in children. Despite its beneficial effect on clinical course of the disease, its use has been associated with a number of side-effects. This prompted us to study the influence of cyclosporine A on the coagulation cascade in nephrotic children. We examined thrombinogenesis in 16 children in remission of steroid-dependent idiopathic nephrotic syndrome treated with cyclosporine A. The concentrations of F1 + 2 prothrombin fragments and thrombin-antithrombin complexes were used as markers of coagulation cascade activation. The results were compared between 18 children with INS relapse who had responded to 8-week glucocorticoid treatment (not treated with cyclosporine A) and 20 healthy subjects. We found an increased concentration of F1 + 2 prothrombin fragments in children treated with CsA, while in children after 8 weeks of glicocorticoid therapy the concentration of this marker was comparable to that in the controls. Since we observed similar biochemical disturbances in both INS groups, we suggested that cyclosporine A was able to stimulate coagulation that might lead to an increased risk of thomboembolic events in children with clinical remission of INS.

Adolescent↗

PubMed2003

[Analysis of renal replacement therapy in patients with renal failure].

The article presents the 10-years experience of renal replacement therapy in a single centre. A total of 158 patients were treated in this period. 77 patients (47 F, 30 M, mean age 18.7 +/- 12 yrs) were treated due to chronic renal failure and 81 (35 F, 46 M, mean age 2.1 +/- 1.5 yrs) due to acute failure. 48 (62%) were treated by haemodialysis, 24 (31%) by peritoneal dialysis and 5 (7%) by both methods. Due to the shortage of dialysis units both children and adults were qualified to the dialysis therapy in our centre. Mean age of haemodialysis patients was 22 yrs and of those treated by peritoneal dialysis 13.5 yrs. 7 patients died (9%) and 30 (39%) were transplanted. 15 (19%) were transferred to other centres. The overall mortality was lower than reported by other authors. 4% of patients were tested HBV positive, 13% HCV positive and 9% both HBV and HCV positive and this rates are lower than the average rate in chronic dialysis patients in Poland. Our experience allows us to conclude that adult patients may be successfully treated in paediatric dialysis centres.

Adolescent↗

PubMed2003

[Concentration of tissue plasminogen activator and its inhibitor 1 in cyclosporine A-treated children with idiopathic nephrotic syndrome].

UNLABELLED: Patients with idiopathic nephrotic syndrome (INS) are at increased risk of thromboembolic events at every stage of the disease. We assessed the function of the coagulation cascade and fibrinolysis in stable remission of INS, in children treated with cyclosporine A. MATERIAL: The study group consisted of 17 children (10 M, 7 F; mean age 8.5 +/- 3.2 years, range 4-18 years) with 2 month-remission of steroid-dependent INS diagnosed according to the international criteria and 20 healthy, age-matched children, and 18 children in long-term INS remission serving as controls. The children with INS relapse were treated with cyclosporine A (to maintain the drug concentration value between 80 and 150 ng/ml) and low doses of steroids, according to a standard protocol. METHODS: Fibrinolysis was assessed by measurement of tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor (PAI-1) concentrations, whereas activation of thrombinogenesis was detected by F1 + 2 prothrombin fragment concentration. Additionally, we measured selected coagulation (concentration of thrombin-antithrombin complexes, fibrinogen concentration, prothrombin time, activated partial thromboplastin time, platelet count) and biochemical (serum albumin, cholesterol, creatinine concentration) factors. RESULTS: In children treated with cyclosporine A increased concentrations of t-PA and PAI-1 were found (p < 0.01). The concentration of F1 + 2 prothrombin fragments was also higher when compared to controls (p < 0.05). We found also increased total cholesterol, and lower creatinine concentration in the study group. CONCLUSION: Children with remission of idiopathic nephrotic syndrome treated with cyclosporine A show increased concentration of t-PA and PAI-1 and thrombinogenesis. Despite clinical and biochemical remission they may still remain at high risk of thrombosis or endothelial injury.

Adolescent↗

PubMed2003

[Acute renal failure in the course of IgA nephropathy in a 16-year-old boy].

Acute renal failure (ARF) is a rare presentation of IgA nephropathy (IgAN). It can be associated with the episodes of macroscopic haematuria, being then usually reversible, or it develops in the course of progressive glomerulopathy with extracapillary proliferation. In the first case ARF is attributed to tubular obstruction by red blood cell casts. We present the case of a 16-year-old boy with non-oliguric ARF in the course of IgAN. He was admitted to the urology unit with 4-day history of gross haematuria, severe loin pain, fever and vomiting. A year before admission he had a short episode of macrohaematuria without any other accompanying symptoms. His family history was not relevant. As the patient was suspected to have acute renal colic in the course of nephrolithiasis, intravenous urography was performed. Since no urinary tract visualisation was obtained, laboratory investigation was carried out revealing marked renal dysfunction with serum creatinine level of 743.3 mumol/l and serum urea of 49.3 mmol/l. The patient was transferred to our department, where conservative treatment was administered (dialysis was not instituted). A rapid improvement in renal function was observed; it returned to normal within 2 weeks. The biopsy findings were consistent with IgAN.

Acute Kidney Injury↗

PubMed2003

[Denys-Drash syndrome: a case report].

Nephrotic syndrome (NS) rarely develops before the age of 1 year. The case is presented of nephrotic syndrome occurring in the form of Denys-Drash syndrome. In a newborn of female sex in birth certificate, dysmorphia was found of the external urogenital organs. The karyotype was 46XY. Massive proteinuria, low total serum protein level, dysproteinaemia, hypercholesterolaemia justified the diagnosis of NS. In renal biopsy performed diffuse mesangial fibrosis was found. The progression of renal insufficiency was very rapid and within few weeks terminal renal failure developed. The parents refused consent to renal replacement treatment. The baby died at the age of 102 days. The autopsy examination confirmed renal changes in the form of diffuse fibrosis; gonads of testicular structure were found in the abdominal cavity.

Denys-Drash Syndrome↗

PubMed2003

[Assessment of children at the beginning of renal replacement therapy in Lodz 1990-2000].

The time of patients' referral to dialysis predicts the clinical outcome of the therapy and significantly influences the mortality rate. The aim of the study was to assess the clinical and nutritional status and selected biochemical parameters (serum creatinine, urea, bicarbonate, calcium, albumin concentration) at the beginning of renal replacement therapy. We analysed medical history of 46 children (24 boys; 22 girls) aged 1 month-18 years (mean age 13.1 +/- 5.5 years). We divided them into late-referral and early-referral groups. 56% of the children were under nephrological care before the beginning of dialysis treatment. However, in 44% of the cases renal insufficiency had not been diagnosed before. It was found that the children who received no nephrological care in the past demonstrated significantly worse clinical and biochemical status at the beginning of the renal replacement therapy.

Adolescent↗

PubMed2003

[Beneficial effect of angiotensin converting enzyme inhibitor treatment in severe cystine urolithiasis].

Cystinuria is an autosomal recessive defect in transepithelial transport of dibasic amino acids (e.g. cystine) which involves the proximal canaliculi, small intestine and central nervous system. It is the least common cause of nephrolithiasis, accounting for 1 to 3% of renal calculi. The natural course of the disease, characterised by recurrent stone formation, can frequently lead to renal failure, if left untreated. Until recently, treatment of cystinuria has been limited to symptomatic management including intensive hydration and urine alkalinisation. Different drugs that react with cystine to form soluble complexes have been used but their efficacy remains questionable. We present the case of a 6-year-old boy with severe, recurrent cystine urolithiasis treated with captopril. The diagnosis of cystine urolithiasis was established after a 3-year course of clinically apparent nephrolithiasis, characterised by stone passage. At the age of 5 years he underwent lithotripsy and nephrolithotomy for removal of staghorn calculi. Since then treatment with citrate and magnesium supplementation combined with captopril was introduced. After a follow-up of 12 months the patient remained stone-free. Urinary cystine decreased from 230 to 136 mg per gram creatinine. We conclude that captopril can be useful in the treatment of cystine urolithiasis in children.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2003

[The results of conservative treatment of oxalate urolithiasis in children].

UNLABELLED: Hyperoxaluria is defined as urinary oxalate excretion exceeding 0.45 mmol/1.73 m2/day and accounts for 15% of recurrent urolithiasis. There have been only a few reports on the prevalence and treatment of oxalate urolithiasis in children. THE AIM: Of the study was to assess the efficacy and safety of the protocol of intensive and combined treatment of hyperoxaluria in children. MATERIAL AND METHODS: Seventeen children at the mean age of 11.5 +/- 4.5 years with positive history of urolithiasis and diagnosis of hyperoxaluria were studied. In this group hyperoxaluria was an isolated defect in 9 of 17 children, but in 3/17 it was accompanied by hyperuricosuria, in 5/17 by hypomagnesuria and in 1 case by hypercalciuria. During the 12-month period the children were intensively hydrated and received a low-oxalate diet and supplemental therapy with vitamin B6, magnesium, citrates and lactic acid bacteria preparations. RESULTS: In all but one child oxaluria decreased below 0.45 mmol/1.73 m2/day (decrease by 45%). No new stone formation was seen during the observation period. In all patients abdominal pain and haematuria subsided. CONCLUSIONS: We conclude that the intensive, complex, conservative treatment of hyperoxaluria in children is effective and safe. It allows to decrease hyperoxaluria and prevent the recurrence of urolithiasis.

Adolescent↗

PubMed2002

Correlation between early treatment failure and Ki67 antigen expression in blast cells of children with acute lymphoblastic leukaemia before commencing treatment. A retrospective study.

OBJECTIVES: An attempt has been made to demonstrate the value of the immunocytochemical assay of Ki67 antigen expression in blast cells in children with acute lymphoblastic leukaemia (ALL) before initiation of treatment and its correlation with early treatment failure. METHODS: Bone marrow specimens were obtained before treatment from children hospitalised in the years 1997-2000. A total of 60 children diagnosed with ALL have been examined. Immunocytochemical staining for Ki67 expression was based on the ABC technique. RESULTS: Out of 45 children assigned to the low risk group, the presence of Ki67 Ag was demonstrated in 31 cases (68.8%). Out of 15 patients in the high risk group, Ki67 Ag expression in blast cells was positive in 8 children (53.3%). The fraction of immunopositive cells in these groups ranged from 19.8 to 81.3% compared to 5% in the control group. Early treatment failure was observed in both groups and these were closely related to the lack of Ki67 expression observed at the beginning of treatment. CONCLUSION: The results indicate a possible connection between the Ki67 immunonegative blast pattern and early leukaemia progression. It may also justify routine determination of Ki67 Ag before the treatment of ALL is initiated.

Adolescent↗

PubMed2002

Influence of the alpha-1-adrenergic receptor blocker doxazosin on exercise-induced hyperkalemia in hemodialysis patients.

BACKGROUND/AIM: Hyperkalemic responses to both physical exercise and alpha-adrenergic stimulation are enhanced in patients with terminal renal failure. Alpha-adrenergic blockade was found to protect against hyperkalemia during vigorous exercise in healthy men. The aim of the study was to examine the effects of the alpha-adrenergic blocker doxazosin on exercise-induced hyperkalemia in hemodialysis patients. METHODS: In a randomized, placebo-controlled, crossover design study, 15 anuric, chronic hemodialysis patients were included. Doxazosin or placebo was given in a random order for 4 days before exercise. At the end of each phase of the study, a 30-min treadmill exercise test with a constant workload of 2 metabolic equivalents was performed followed by a 30-min recovery period. RESULTS: The patients achieved 64 +/- 3 and 62 +/- 3% of maximal heart rate during the exercise test on doxazosin and placebo, respectively. The baseline plasma concentration of potassium was similar both on active treatment and on placebo (5.1 +/- 0.2 mmol/l on doxazosin and 4.9 +/- 0.1 mmol/l on placebo). The serum potassium concentration increased significantly and to a similar extent during the tests. The mean rates of potassium increment during exercise were 8.4 +/- 1.5 micromol/l/min on doxazosin and 6.9 +/- 1.3 micromol/l/min on placebo. During the recovery period, the serum potassium concentration significantly decreased in both arms of the study. There were no significant changes in plasma sodium, calcium, and phosphate levels during the tests. Hydrogen ion concentration in blood, serum insulin and glucose, and plasma aldosterone and renin activity were similar before the exercise tests. CONCLUSION: Alpha-adrenergic blockade does not modulate the hyperkalemic response to moderate physical exercise in patients with terminal renal failure.

Adrenergic alpha-Antagonists↗

PubMed2002

Nonselective Beta-adrenergic blockade augments fasting hyperkalemia in hemodialysis patients.

BACKGROUND/AIM: Fasting hyperkalemia in patients with end-stage renal failure is a well-documented phenomenon. Both a decreased secretion of insulin and decreased beta-adrenergic receptor sensitivity may take part in this effect. METHODS: Twelve anuric, long-term (6.4 +/- 2.7 years; mean +/- SD) hemodialysis patients underwent three periods of 18-hour fasting (from 6 p.m. to 12 a.m.). At the beginning of each fasting period a single dose of the nonselective beta-blocker, nadolol (80 mg), or the beta(1)-selective blocker, betaxolol (20 mg), or placebo were given in a random order and in blinded fashion. The wash-out period was 7 days. RESULTS: The mean decrease in blood pressure was similar after nadolol and betaxolol (18 +/- 10 vs. 19 +/- 11 mm Hg) as was a decrease in heart rate (20 +/- 3 and 19 +/- 6, respectively). Serum potassium was not different before each of the fasting periods. The increase in serum potassium during fasting was highly significant in each case. The mean increase in serum potassium was 1.2 +/- 0.4 mmol/l after nadolol, 0.9 +/- 0.6 after betaxolol and 0.6 +/- 0.6 after placebo. This effect was significantly larger after nadolol than after placebo (p = 0.01), but this relation was not significant with respect to betaxolol (p = 0.30). Serum insulin as well as glucose decreased significantly and to a similar extent during each fasting period. Plasma aldosterone was unchanged. CONCLUSION: Nonselective beta-adrenergic blockade increases the hyperkalemic effect of fasting in hemodialysis patients.

Adrenergic beta-Antagonists↗

PubMed2002

[Dialysis-related complications in peritoneal dialysis patients].

The hospital records of 56 patients (25M, 31F) with acute or chronic renal failure treated by peritoneal dialysis were retrospectively reviewed. Mean dialysis time was 13 +/- 15 days in acute renal failure and 32 +/- 23 months in chronic renal failure. The incidence of infectious (exit site infections and peritonitis) and non-infectious dialysis-related complication was assessed. Exit site infections were significantly more frequent in children aged 5 or less than in older patients (1/9.6 patient-month and 1/26.5 patient-month, respectively, p < 0.001). Such relationship was not found with regard to the incidence of peritonitis. There was a tendency of peritonitis rate to decrease in consecutive years was noted. This can be probably related to an increase in the number of patients, introduction of automated peritoneal dialysis, increasing experience of medical staff and patients themselves.

Acute Kidney Injury↗

PubMed2002

[Pneumoperitoneum and peritonitis in a child treated by continuous ambulatory peritoneal dialysis].

Pneumoperitoneum is a rare complication of peritoneal dialysis, which in most cases occurs soon after the implantation of the peritoneal catheter and does not need any specific treatment. In contrast, pneumoperitoneum due to visceral perforation represents a serious clinical problem and usually needs an urgent surgical intervention. We present a case of a 10-year old girl treated by peritoneal dialysis for 7 months who was admitted to hospital with symptoms of peritonitis and pneumoperitoneum. On admission her condition was severe and visceral perforation was strongly suspected. As her parents did not give consent to surgical treatment, only conservative management was introduced. Peritoneal dialysis was continued and the girl responded well to antibacterial therapy. The final outcome was favourable.

Anti-Infective Agents↗

PubMed2002

Comparison of the cell immunophenotype of metastatic and primary foci in stage IV-S neuroblastoma.

Neuroblastoma represents one of the most frequently developing malignant solid tumours in children. At the time of diagnosis, in more than half of the cases, metastatic cells are also present in the bone marrow. The present study was aimed at immunocytochemical analysis of selected neuropeptide manifestation in metastatic cells of neuroblastoma in bone marrow and at comparing the obtained results with the immunophenotype of parental neuroblastoma cells. The studies were performed on bone marrow material obtained from children treated at the Department of Paediatric Haematology and Oncology, University of Medical Sciences, Poznań, Poland, in 1998-2000. Immunocytochemical analysis of nervous tissue markers (employing the immunomax technique) involved 36 bone marrow preparations obtained from 27 children. The analysis included expression of neuron-specific enolase (NSE), PGP 9.5 protein, substance P (SP), chromogranin A (ChA), bombesin (B), galanin (G), neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP). Close to 90% metastatic cells in bone marrow were found to exhibit NSE+SP+B+ phenotype and over a half of the cells manifested additionally expression of PGP 9.5+ChA+NPY+. Comparison of the obtained results with the immunophenotype of neuroblastoma cells obtained directly from the primary tumour demonstrated high correlation of NSE, SP and PGP 9.5 expression. Due to the relative ease of obtaining the bone marrow material and absence of neuromarkers in bone marrow metastatic cells in solid tumours other than neuroblastoma, determination of immunophenotype of the cells may represent a valuable supplementation in preliminary diagnosis of this tumour in children.

Adolescent↗

PubMed2002

[The relation between plasma leptin concentration and body fat mass in patients with rheumatoid arthritis].

The prospective, cross-sectional study was undertaken to evaluate the relation between the fat mass and serum leptin level in patients with rheumatoid arthritis (RA). Low body mass and anorexia are commonly found in patients with RA. Inflammatory cytokines may significantly influence the secretion of anorectic hormone--leptin--that was confirmed in both experimental and clinical studies. Fifty-two non-diabetic and non-obese patients (38 females, 14 males) were studied. Mean age was 56 +/- 11 years and mean body mass index (BMI) 24.6 +/- 4.1 kg/m2. The disease activity score (DAS) was 3.9 +/- 1.4; range 1.4-7.4, and disease duration 8.1 +/- 6.7 years. Serum leptin was measured by ELISA and body composition by double X-ray densitometry. Mean serum leptin concentration was 2.8 +/- 1.4 ng/ml in patients with RA was lower than in the control group (4.2 +/- 2.0). In a simple regression analysis leptin did not correlate with BMI (R Spearman = 0.01), C-reactive protein (R = 0.08), total fat mass (R = 0.08), trunk fat (R = 0.05), limbs fat (R = 0.09) and DAS (R = -0.17). This relation was also not influenced by gender or type of immunosuppressive therapy. In a multiple regression model none of the independent variables explained the significant portion of variance of serum leptin. It is concluded that the physiologic relation of serum leptin to body fat stores is not present in patients with RA.

Aged↗

PubMed2002

[Hypertension in pregnancy--risk factors, prevention and treatment].

The term hypertension in pregnancy stands either for a high blood pressure, which has already developed before pregnancy (i.e., chronic hypertension in pregnancy), or for a pregnancy-associated disease (i.e., pregnancy-induced hypertension). Each form of hypertension may be an isolated phenomenon or constitute a part of the syndrome of preeclampsia or eclampsia. This review focuses mainly on the risk factor assessment, prevention and treatment of hypertension developing during pregnancy. Despite a frequent occurrence of this disease its prevention and treatment is still a subject of debates, and only a limited number of studies, which fulfill the criteria of "evidence-based medicine" have so far been performed in this field. Although the impressive advances in treatment of hypertension in the general population have been done, the choice of drugs and control of hypertension developing during pregnancy is still far from being satisfactory.

Evidence-Based Medicine↗