Echocardiography and sonography of the carotid arteries in diabetics with cerebrovascular stroke

The incidence of cerebrovascular attacks (CVA) in diabetics is 2-3 times higher as compared with the non-diabetic population. The objective of the present work was to evaluate etiological factors by means of echocardiography and sonography of the carotid arteries. The authors evaluated retrospectively findings of these examinations in 253 patients with CVA in a group of diabetic and non-diabetic patients as well as in a group of patients with atrial fibrillations or sinus rhythm. In patients with a sinus rhythm the presence of diabetes was associated with a more frequent finding of atherosclerotic changes, significant stenoses of the carotid vessels (2% as compared with 8%, p < 0.05) as well as thickness of the intima in the carotid bulbus (0.78 as compared with 0.96 mm, p < 0.05). Conversely when evaluating signs of thromboembolic risk, i.e. the size of the left ventricle (42 vs. 40 mm, n.s.) and ejection fraction of the left ventricle (55% vs. 50%, n.s.) no statistical significance in the difference of parameters was found. In the sub-group of patients with atrial fibrillation, who accounted for 28% of the group, the authors did not find when comparing diabetic and non-diabetic patients, any difference as regards the presence of significant stenoses in the carotid arteries nor in the thickness of the intima. There was no statistically significant difference in the size of the left atrium and left ventricular function. The findings suggest the possibility that the increased risk of ischaemic CVA in diabetic patients is caused by the atherosclerotic process in the carotid vessels and not a higher risk of embolism of cardiac origin.     

Pregnancy in patients with hereditary spherocytosis

The influence of pregnancy on the course of hereditary spherocytosis was investigated in 21 women during their 44 pregnancies. Fourteen pregnancies were followed up directly, 30 were evaluated from anamnestic data. In the majority of investigated women with hereditary spherocytosis pregnancy caused no problems. When complications developed, they were not serious as a rule. Only about one third of pregnancies in non-splenectomized women developed anaemia or anaemia deteriorated. In the latter enhanced haemolysis participated. In splenectomized patients the incidence of complaints was minimal.     

Distribution of the extracellular matrix glycoproteins in ependymomas--an immunohistochemical study with follow-up analysis

The extracellular matrix (ECM) plays a critical role in influencing the biological behavior of brain tumors and the diagnostic detection of ECM components in ependymomas might be of prognostic value. In the present study we evaluated immunohistochemically the expression of a spectrum of ECM glycoproteins (tenascin, vitronectin, fibronectin, laminin, collagen types II, IV and VI) in a series of 36 pediatric intracranial ependymomas. The distribution of the ECM glycoproteins was evaluated both within the tumor tissue and at the tumor invasion front, and the prognostic value of the results was tested in a survival analysis. The expression of most of the ECM glycoproteins was associated only with blood vessels. Tenascin and vitronectin were found in a more diffuse pattern around the tumor cells and at the tumor invasion fronts of several cases. The progression-free survival was significantly decreased for patients with tenascin positive tumors (in any of the studied compartments) and for the tumors with vitronectin accumulation at their invasion fronts. In one ependymoma containing foci of cartilage with metaplastic ossification we demonstrated that collagen types II and VI and tenascin were present in ECM of both the cartilage and the ependymoma, and were accompanied by areas of necrosis and dystrophic calcifications. We suggest, that the rare simultaneous production of the specific ECM components might lead to the formation of chondroid areas in ependymomas. An abundant production of some ECM glycoproteins (tenascin and vitronectin) is present in a proportion of ependymomas and its immunohistochemical detection is of prognostic relevance.     

Cytoprotective effects of amifostine in the treatment of tumors

An efficient therapy of patients with tumorous diseases should include maximum killing of malignant cells with minimal damage to cells in healthy tissues. Radiotherapy and chemotherapy are frequently associated with a series of undesirable effects. Side effects related to the therapy may unfavorably influence quality of life for a short or long period of time, may cause the need to decrease the dosage or shorten the overall period of treatment or survival of the patient. Therefore, particular attention has recently been paid to compounds, which mitigate or eliminate the undesirable effects of the therapy. A way to decrease toxicity is the administration of radioprotective or chemoprotective compounds. The cytoprotection of healthy tissues by compounds from the aminothiol group is one of the most promising directions of research and clinical practice. Amifostin protects healthy tissue from damage induced by radio- or chemotherapy. In comparison with patients treated by radiotherapy only, radiotherapy supplemented with amifostin proved to cause significantly less acute and late untoward effects of therapy. The paper describes the possibilities of using radioprotective drugs, especially amifostin, in the therapy of tumors with particular emphasis to the needs of physicians dealing with the problems of internal medicine.     

Hypothyroidism and heart failure

Effects of thyroid gland hormones on cardiovascular system have been known for many years. Thyroid gland hormones deficiency is connected with a range of metabolic and hemodynamic changes which can contribute to a genesis of heart failure. Recent works refer to an importance of connection of thyroid gland hormones metabolism with heart insufficiency pathophysiology. That is especially a syndrome of a low trijodthyronin level marked as euthyroid sick syndrome which is significantly more frequent in patients with chronic heart failure compared to a population of healthy individuals. Recent clinical works proved that treatment administration of thyroid gland hormones to patients with heart failure is connected with favourable hemodynamic changes and increased working capacity if the treatment is well tolerated.     

Budd-Chiari syndrome--hematologists' part in the multidisciplinary approach

Budd-Chiari syndrome presents a serious disease with a complex etiology and clinical manifestations, which is associated with high morbidity and mortality. An early diagnosis and therapy is mandatory due to the severity of disease and therapy contains the treatment of underlying disorder, anticoagulation therapy and therapy of liver impairment. We discuss hematologists' contribution to the diagnostic approach and therapy of this syndrome.