[Fibronectin--a multifunctional glycoprotein]

Fibronectin is an ubiquitous glycoprotein that plays an important role in many biological processes. Plasma and cellular fibronectins are similar, but not identical molecular structures. Cellular fibronectin has ED1 and ED2 components that do no exist in plasma fibronectin. Human plasma fibronectin is a high molecular weight (440-530 kD) glycoprotein, consisting of two nearly identical subunits disulfide-bridged close to their C-terminal ends. Tetrapeptide "RGDS" and polypeptide "CS1" are receptors for cell surface integrins. Numerous receptors for macromolecules enable to bridging of fibronectin to the fibrin, heparin, factor XIIIa, plasminogen, tissue type plasminogen activator, collagen, bacterial and virus glycoproteins. Cellular fibronectin is a component of the fibrillar extracellular matrix compartment and basal membrane of all tissues that are involved in the tissue modelling in embryogenesis and tissue remodelling in wound healing. Plasma fibronectin is involved in the mechanisms of immune defence, immune surveillance and hemostasis.

[Our experience in the treatment of painful shoulder syndrome by Streptofil]

Streptofil is a biological product obtained from streptococcus beta haemoliticus, with molecular weight of 700 D and antigenic properties. It has anti-inflammatory, antibacterial and reparative effects. The objective of our study was to test the Streptofil therapy effect on painful shoulder syndrome. Testing included 73 patients. One ml of Streptofil was used locally in the projection of m. supraspinatus insertion five days a week; treatment lasted 3 weeks in average. Therapy effect estimate was made according to Constant and Murley method. As full clinical effect we considered pain loss and complete function restitution (score 90-100) and incomplete reduction or loss of pain and incomplete function recovery (score less than 90). Control radiography was performed only in patients with calcification tendinitis. In 46% of patients tendon calcification had disappeared. Full clinical effect was achieved in 80% of the patients in whom tendon calcification disappeared after therapy, and in 58% of those in whom it remained. This finding coincided with results obtained in the group of patients without tendon calcification.

[Principles of the current therapy in autoimmune diseases]

Presented are principles of systemic connective tissue diseases therapy (SCTD) based on data from literature, our experience and reported at international meetings held in Europe during last years special attention has been paid to the advances and perspectives in the treatment of rheumatoid arthitis (RA) and systemic lupus erythematosus (SEL).

[The antiphospholipid syndrome in systemic connective tissue diseases]

The aim of the study was to prove the incidence of antiphospholipid syndrome (APS) in systemic connective tissue disease (SCTD), especially in systemic lupus erythematosus (SLE) and to find out serologic markers of APS. Of 94 patients with SCTD followed up in the last three years 80 had SLE, 7 Sjogren's syndrome, 3 systemic vasculitis, 2 combined systemic connective tissue disease, 1 rheumatoid arthritis, 1 Sjogren's syndrome with vasculitis. Antiphospholipid antibodies (ApSt) were determined by ELISA method. In 31 of 80 patients with SLE (38.07%) antiphospholipid antibodies were proved. In lo of 31 (32.26%) signs of systemic lupus or the presence of APS markers have not been found, while 21 of 31 (67.74%) had some of clinical manifestations of APS (most commonly thrombocytopenia or vascular thrombosis) with evolution of the basic disease. Among our patients with SLE the most common finding was IgG antibody isotype-in 14 or 66.66% of cases. In 5 of 7 patients with Sjogren's syndrome ApAt were proved without clinical evolution of the basic disease and APS. Only 2 of 7 patients of this group showed, together with more increased ApAt, mild evolution of the basic disease and manifestation of APS (livado reticularis and recurrent venous thrombosis).

[Importance of immunomorphometric evaluation of the size and number of megakaryocytes in normal and pathologic bone marrow]

The aim of the present study was to evaluate the significance of immunomorphometric assessment of megakaryocyte size and number in normal and pathologic human bone marrow. Thus, we compared morphometric characteristics of megakaryocytes in 56 bone marrow trephine biopsies stained by immunohistochemical and conventional techniques. Morphometric results showed that precise megakaryocyte size in normal and pathologic samples can be calculated even by using conventional staining technique, but only employing specific stereological corrections. Immunomorphometric evaluation revealed populations of "small" megakaryocytes (< 14 microns), "morphologically unrecognized" by conventional staining technique (promegakaryoblasts in normal and stimulated as well as micromegakaryocytes in pathologic bone marrow). In patients with normal and stimulated megakaryocytopoises percentage of "small" megakaryocytes was generally low (10.6% and 14%, respect.); so, megakaryocyte number was similar in immunohistochemically and conventionally stained sections. In contrast, percentages of "small" megakaryocytes were significantly higher in patients with stem cell disorders (namely, myelodisplastic syndrome and chronic granulocytic leukaemia), as compared to controls (35.3% in MDS; 22.9% in CML and 10.6% in controls). In those patients megakaryocyte numbers were more sensitively detected by immunohistochemistry than by conventional staining.

[Drug therapy of nocturnal enuresis]

Bed wetting is a disorder the origin of which different authors find in different etiopathogenetic mechanisms. Depending on the etiologic concept different therapeutic methods have been used. Treating bed wetting, authors claiming that the basic cause is a disorder in the integration of central vegetative functions and sleep, most frequently administer anticholinergic agents, making use of their marginal central anticholinergic effect and their impact on sleep phases. For children who wet in bed, having an urodynamic disorder and the disordered function of the pelvic floor musculature, effective drugs would be those with peripheral anticholinergic effects as well as pelvic floor musculature reeducation exercises. In conformity with the current understanding of the bed wetting etiology due to disordered Adiuretin excretion circadian rhythm, the applied drug is synthetic Adiuretin. It has been pointed out that bed wetting, being a heterogeneous group of disorders, should be etiologically classified by additional diagnostic methods, and that the treatment should include aimed etiological therapeutical methods.

[Diseases of the brachial plexus after surgery and irradiation of breast cancer (author's transl)]

The authors evaluated retrospectively the medical records of 1028 female and two male patients operated upon and post-irradiated because of a breast cancer. Thirty-nine among the female patients suffered from a plexus disease. When considering the reasons for the formation of this disease, one must not only suppose that the operation method and the influence of the dose is at its origin, but the hyperemization and hyperhydration which may develop in the early postoperative phase or due to hormonal action have to be taken into consideration, too. The following conclusions were drawn for patients submitted to radical operations: 1. The irradiations should not be started much earlier than twenty days after the operation. 2. The dose calculation and beginning of irradiations should be controlled very carefully for patients aged below 45 and/or patients presenting an oedema of the arm. 3. No maximum doses are administered to patients treated by hormonal and/or pharmacological therapy (not more than 42 to 45 Gy).