Biomedical subjects
Publications and source records attributed to J Cermák.
The authors present the case--history of a female patient with an intrapericardial cyst in the pericardium which exerted pressure and caused thus discomfort to the patient. After extirpation of the cyst via sternotomy the patient has no complaints. The authors draw attention to the rare occurrence of these cyst in the pericardial cavity and to pitfalls of diagnosis and surgery of this located cysts.
Nine patients with anemia of chronic renal failure were treated with recombinant human erythropoietin (rHuEPO) in dose 50-150 IU/kg/week. After 8 weeks the treatment was maintained with 30-50 IU/kg/week for one year. A significant increase of hemoglobin (Hb) level and red blood cell (RBC) count was observed in all patients. Administration of rHUEPO maintained Hb level higher than 100 milligrams and RBC count above 3.0 x 10(12)/l. Iron stores decreased in all patients. Parameters reflecting either the real amount of iron available for erythropoiesis or iron stores in erythroid precursors, i.e. red cell ferritin (eF), free erythrocyte protoporphyrin (FEP) and transferrin saturation (satTRF) were the most reliable tools for diagnosis of iron deficient erythropoiesis. Serum ferritin (sF) was not decreased in most patients, however, sF level was below 50 micrograms/l in all patients at the time of diagnosis of iron deficiency. Iron supplementation in a daily dose allowing absorption of 100mg of elementary iron was sufficient to cover the increased demand for iron in rHuEPO treated patients.
Large, declining beech (Fagus sylvatica L.) trees (diameter at breast height = 50 cm), growing on heavy clay soils in the highlands near Zurich, Switzerland, were amply irrigated in late summer. During irrigation, the xylem sap flow rate, Q(wt), was measured by the stem-tissue heat balance method with internal heating and sensing. Only a gradual and slight increase in Q(wt) in response to irrigation was observed in the control trees, whereas Q(wt) in the declining trees, whose transpiration rates were only 2-20% those of the control trees, increased 2-5 times within minutes. This suggests, that severe local drought was the major factor limiting tree growth at the site. The extent of the response permits estimation of the supply-limited (soil water) and demand-limited (tree structure) components of stress. Drought caused a decline in Q(wt) in the trees with short crowns and limited root systems that had originally been growing in dense canopies and had become suddenly exposed to full illumination as a result of a severe wind storm and thinning. Trees with deep, narrow, dense crowns, growing in more open places and adapted over a long period to high irradiance remained healthy during drought. Prolonged, periodic water shortage reduced the amount of foliage up to 90% but during drought stimulated the growth of fine roots in the surface and upper soil layers. The stem conductive systems of the declining trees were still partially functional.
The authors submit the results of the follow-up of the dynamics of 10 acute stage plasma proteins (up to the 7th day) in two surgical model situations: 1. planned operation of colorectal carcinoma by an intraabdominal approach and 2. operation of extensive varicosities of the lower extremities. As reference groups 3. healthy subjects (blood donors) were used and 4. patients with developed postoperative sepsis. Based on the results, the authors provide evidence of the asset of some selected indicators they assessed such as transferrin, prealbumin, alpha-1 acid glycoprotein (orosomucoid) and C reactive protein, for the early diagnosis of postoperative septic complications.
The authors publish their initial experience with wedge-shaped pulmonary biopsy by the endoscopic route. The group is formed by 18 patients who were indicated for the operation on account of a disseminated pulmonary process in order to assess the micromorphological appearance of the affected lung tissue. Two patients developed a complication during operation which therefore was completed by minor thoracotomy. In who patients the authors observed after operation slow expansion of the pulmonary parenchyma. No death after the operation was recorded. The authors assume, based on their initial experience, that this operation will soon be included among common diagnostic operations and will help to facilitate the diagnosis and selection of treatment in patients with disseminated lung disease.
Trunk-tissue heat balance, volumetric and staining methods were used to study xylem water flow rates and pathways in mature Norway spruce (Picea abies (L.) Karst.) and pedunculate oak (Quercus robur L.) trees. The radial profile of flow velocity was confirmed to be symmetrical in spruce, i.e., maximum flow velocity was in the center of the conducting xylem and tailed with low amplitude (about 30 cm h(-1)) in the direction of the cambium and heartwood. Variability around the trunk was high. In contrast, in oak, the radial profile of flow velocity was highly asymmetrical, reaching a peak of about 45 m h(-1) in the youngest growth ring and tailing centripetally for about 10 rings, but variability around the trunk was less, under non-limiting soil water conditions, than in spruce. In spruce, the flow rate increased abruptly within seconds when the tree was severed while immersed in water, and then decreased gradually, showing significant root resistance. We conclude that water flow through an absorbing cut surface differs from the flow higher in a tree trunk because of the presence of hydraulic capacitances in the conductive pathways. The staining technique always yielded higher estimates of flow velocity than the non-destructive tree-trunk heat balance method.
In 1970-1990 in the Institute of Lung Diseases in Prague a total of 180 mediastinoscopies were performed. In the submitted paper the authors discuss 169 of these examinations. In this group 20 examinations were associated with a peroperative or postoperative complications, i.e. a total of 12% of the examinations. However, only in three patients, i.e. cca 1.8% from the total number serious complications were involved which were unequivocally specific for mediastinoscopy. In two instances massive haemorrhage occurred from lacerated mediastinal vessels associated with superior vena cava syndrome and in one case pneumothorax developed. All these complications were controlled by surgical intervention made in time. The most frequent complication after mediastinoscopic examination was retention of a serohaematoma in the wound--this was recorded 11 times. The cause of its development is the method of preparation and anatomical conditions in the pre- and paratracheal space. The percentage of this complication can be reduced by using active drainage of the mediastinum.
The authors present a report on the treatment of haemorrhoids by elastic ligature at the Second Surgical Clinic in Prague in 93 patients. In 75% they evaluate the results as excellent, in 22% as very good, only two patients, i.e. 3%, did not improve. The method is reliable, provides very good results and involves a low risk.
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In 1969 to 1989 in the Research Institute of Tuberculosis and Respiratory Diseases in Prague a total of 3583 thoracotomies were performed. Of these during the postoperative period 29 patients were re-operated on account of continuing haemorrhage into the pleural cavity. This is approximately 0.8% of all thoracotomies. Sixteen patients had to be re-operated within 12 hours after operation, 12 patients were re-operated later than 12 hours after operation but within 24 hours, one patient was re-operated later than 24 hours after operation. The cause of haemothorax was in the first place capillary haemorrhage from a lacerated pleura, in the second place haemorrhage from a severe intercostal artery at the very site of the thoracotomy. Other causes of haemorrhage such as haemorrhage from the bronchial artery and its branches are not frequent. None of the patients had to be re-operated on account of haemorrhage from the major arteries of the pulmonary hilus. Administration of small doses of heparin before and after operation did not influence the number of re-operations on account of haemothorax.
The basic ferritin level in red cells was examined in 60 healthy volunteers and in 110 patients with various diseases of the red cell series. From samples of heparinized whole blood first leucocytes were removed and then they were haemolyzed. After subsequent centrifuging in the supernatant the basic ferritin content was assessed by means of an Amersham Ferritin RIA kit (Amersham, Great Britain). Normal values in healthy volunteers varied between 3.2 and 30.2 ag/ery. In patients with iron deficiency the values were significantly reduced, in patients with pernicious anaemia, beta-thalassemia minor, hereditary spherocytosis and glucose-6-phosphate dehydrogenase deficiency or pyruvate kinase deficiency the levels of red cell ferritin were significantly elevated, as compared with the control group. The red cell ferritin level depends on the iron supply to cells of the red cell series and the amount needed for erythropoiesis. A reduced supply in sideropenia leads to a reduced level of red cell ferritin, in haemolytic anaemia its level depends on the generally elevated iron supply in the organism and possibly impaired haemoglobin synthesis, on the one hand, and concurrent elevated iron requirements in case of hyperplasia of red cell formation, on the other hand. Assessment of red cell ferritin is important not only for accurate estimation of the amount of iron available in the cell for haeme formation but also to elucidate the pathogenesis of some changes of iron metabolism in diseases of the red cell series.
174 serum ferritin assays in 121 patients with various haemolytic disorders have been performed. The mean serum ferritin levels were significantly increased in all these disorders in contrast to healthy controls. The highest serum ferritin levels were found in pyruvate kinase (PK) deficiency, moderate increase was observed in hereditary sphaerocytosis (HS) and in autoimmune haemolytic anaemia (AIHA) with massive haemolysis and in glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Mild elevation of serum ferritin levels was depicted in paroxysmal nocturnal haemoglobinuria (PNH), in beta thalassaemia minor and in other types of haemoglobinopathies. The range of values was associated with a degree of haemolysis and its relation to duration of the disease was not apparent in most cases. Highly significant differences between serum ferritin levels in splenectomized and non-splenectomized patients with HS and between serum ferritin levels in patients with AIHA with massive haemolysis or in remission were found. As compared to normal controls, significant increase of serum ferritin levels was observed even in patients with AIHA in remission or in splenectomized patients with HS. In two patients with PK deficiency the levels exceeding 2,000 micrograms/l indicated manifest iron overload. A reliability of serum ferritin assay as an index of iron stores in haemolytic disorders has been discussed.
The paper gives a brief account of alpha interferon (IFN) production employed for clinical use in oncology. In onco-haematology, in particular, the alpha IFN effect in hairy-cell leukaemia and chronic myeloid leukaemia is surprisingly favorable. This study analyzes the IFN therapeutical results in 11 patients with hairy-cell leukaemia during the first six months of treatment. For various reasons, four patients were not treated with IFN long enough to attain a therapeutic effect. One female patient with splenomegaly failed to respond to the treatment. In six patients the treatment was successful. Satisfactory partial remission was induced in five of these patients, in one--a complete remission. The paper briefly discusses the present knowledge of how IFN works. The effect is three-fold: anti-viral, immunomodulatory, and anti-proliferative. In hairy-cell leukaemia, the IFN anti-proliferative effect on the leukaemic cell population was observed in most cases. In conclusion, the authors, drawing on their own experience and literary data, propose indications, dosage, length of IFN therapy and describe side-effects in hairy-cell leukaemia, treated with alpha IFN. In natural and recombination forms, the alpha IFN can be considered important addition to the limited therapeutical options of hairy-cell leukaemia treatment.
The solar equivalent leaf area (A(s)), a simply and easily determined biometrical parameter of leaves, trees and stands, was derived theoretically. The parameter is defined as projected leaf area weighted for the time integral of irradiance at a given location in the canopy relative to that of fully irradiated leaves at the top of the canopy. The efficiency of A(s) as a basis for estimating stand-area transpiration of a mature oak (Quercus robur L.) forest from measurements of transpiration by individual trees was compared with that of other stand and tree characteristics. Stand transpiration estimates based on A(s) were more precise and less prone to systematic error than estimates based on basal area, timber volume, projected tree crown area, projected leaf area, or leaf dry mass. Solar equivalent leaf area reflects both the amount and the physiological properties of leaves and can be used as a measure of tree size and functional capacity. It can be calculated from ordinary forest inventory data on trees and stands, adjusted according to simple phyllometric data. It appears to have wide application in ecological and forestry studies for relating the physiological characteristics of individual leaves to those of entire trees or stands.
Circulating immune complexes (CIC) were measured at the time of diagnosis in 81 patients with acute leukemia or blast crisis of chronic myeloid leukemia using precipitation by 3.75% polyethyleneglycol. Elevated CIC levels did not adversely influence complete remission duration and survival, patients with normal CIC levels exhibited mostly shorter remission and survival than those with elevated or borderline levels. No significant correlation was observed between CIC levels and Hb, WBC, CBC, platelet count, age, serum bilirubin, total protein, fibrinogen, AST and ALT levels, presence of hepatosplenomegaly and/or lymphadenopathy, HbSAg positivity, complete remission duration and survival. The lack of correlation may be caused by altered immune response in leukemic patients, but the obtained results may also be affected by the nonspecific nature of the method used for the detection. Simultaneous detection of CIC levels by multiple tests and evaluation not only of the number but also of the composition and size of CIC may decrease the incidence of false results. Nevertheless, only the establishment of antigen-specific assays may resolve the controversies in the detection of CIC and thus contribute to a more precise assessment of the role of CIC in prognosis of cancer, as well as to the verification of reliability of using CIC as a tumor marker.
Low-density blood cells from patients with refractory anemia with excess of blasts (RAEB) and RAEB in transformation (RAEB-T) release a high molecular weight inhibitory substance that reduces the entry of normal progenitor cells of granulocytes and macrophages (CFU-GM) into the S-phase. Out of 20 patients with refractory anemia (RA and RAS) only 3 were positive. One patient with CMML was negative. Serial examination of 3 patients (two RA and one CMML) revealed that the production of the inhibitory activity preceded the development of the disease into RAEB, RAEB-T, or AML. With one exception, the inhibitory activity in positive cases was neutralized by antiserum against human placental ferritin.
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