[Detection of antibodies against pancreatic islet cells in clinical practice]

Development of diabetes mellitus caused by pancreatic beta-cell destruction of autoimmune origin is the result of a long lasting process. The most easily examinable feature of this stage is the occurrence of the islet cell antibodies. The sera which are positive for islet cell cytoplasmic antibodies (ICA), examined by indirect immunofluorescence, contain a mixture of antibodies. The glutamic acid decarbocylase (GAD), the tyrosin phosphatase (IA2), the insulin, and the GM2-1 glycolipid can be the targets of these antibodies. One can routinely examine the ICA, the GADA, the IA2 antibodies. The detection of antibodies against insulin (IAA) and GM-2-1 glycolipid is not invented in the routine laboratory work. The aim of the authors was the evaluation of clinical significance of occurrence of islet cell antibodies: one hundred and eighteen nondiabetic children an adult human being without known diabetic first degree relatives and 366 type 1 diabetic children and adult patients served as controls. The authors evaluated the predictive value of the different islet cell antibodies to the development of type 1 diabetes mellitus in 596 nondiabetic children with type 1 diabetic first degree relatives. The authors looked for markers of beta-cell destruction among sera of 320 diabetics manifested after 30 years of age with at least half a year of non-insulin-dependency and in the sera of 68 females suffered from gestational diabetes after 0-14 years of the index pregnancy. Finally the authors report 7 cases in which the examination of islet cell antibodies helped the diagnosis and classification of diabetes mellitus. Indirect immunofluorescence method was used for the detection of ICA, radioimmunoassay for that of GADA and IA2 antibodies. There was no positive reaction for ICA and GADA in the nondiabetic population without diabetic first degree relatives. Among the freshly diagnosed type 1 diabetic children 39% were positive for only ICA, 44% for only GADA and 80% for any antibodies. Among the freshly manifested type 1 diabetic adults ICA positivity only was observed in 21%, GADA positivity only in 7.1% and 93% for any antibodies. From the 595 nondiabetic children with type 1 diabetic first degree relatives 23 were positive for ICA, from whom 5 became diabetic during a two years observation period. These diabetic children had multiplex autoantibodies besides ICA. One child from this group, who was negative for ICA became diabetic, too. Among type 2 diabetic patients 13% were positive for ICA alone, 17% were positive for GADA alone and 27% were positive for any antibodies. The insulin dependency manifested in a short time was associated with antibody positivity. Among the gestational diabetics 10 were found positive for ICA. From them, 7 were type 1 diabetics, and 3 were type 2 diabetics at the time of the detection of antibodies. The authors suggest the need of determination of islet cell antibodies in the group of nondiabetic first degree relatives of type 1 diabetic patients (ICA, GADA, IA2 and IAA), in the group of non-insulin-dependent diabetics (ICA and GADA) as a screening for later insulin dependency, and in gestational diabetes after delivery (ICA) as screening for type 1 diabetes mellitus.

[Percutaneous drainage in the treatment of accidentally discovered hydatid cyst in patients with polycystic liver]

This article report on a not very well-known therapeutical procedure used among only fairly diagnosed cases based on international and Hungarian experiences. In Hungary echinococcus cyst of the liver is mostly treated surgically (the average mortality rate of liver resection is 0-6.3%). In many places the percutan puncture and drainage are contraindicated in case of echinococcus cysts. The authors assert that the percutaneous treatment of echinococcus cysts in proper technical and methodic circumstances in safe regarding the previous studies and their own data obtained of a few cases, and describe the technique and raise some question in them. Drainage treatment is very well tolerated by the patients it reduces the duration (of time) and the cost of the hospitalization.

[Adenomyomatosis of the gallbladder]

A 64-year-old male patient was reported, surveying radiology and pathology of the adenomyomatosis. The authors emphasize the role of high resolution ultrasound and computer tomography in the diagnosis of gallbladder adenomyomatosis. Intramural cystic formation (anechoic diverticula) with echogenic foci and/or reverberation artifacts together with a full or a partial thickening of the gallbladder's wall was considered as the diagnostic criteria of the ultrasound examinations. They assist in finding the proper way among the difficulties of the different diagnosis, in the same time call the attention for the frequently misdiagnosed cases.

[Local fibrinolytic treatment in subtotal pulmonary embolism]

Authors present an interventional radiological technique used for a successful treatment of 12 patients with massive pulmonary embolism. The method for rapid statement of diagnosis and the range of indications are discussed. In massive pulmonary embolism, after a diagnostic angiography, in 12 patient's mechanical thrombus drilling, in 3 cases thrombus aspiration, in 8 cases thrombus explosion and in other 1 balloon recanalisation was performed combined with a low dose (20,000-60,000 IU/h Streptokinase or the double dose of Urokinase) local fibrinolytic infusion. No major complication was observed and all the patients were successfully treated.

[Repeated resection of hepatocellular carcinoma and its recurrences and removal of pulmonary metastases]

A case of a 67 year old male successfully treated local recurrence of previously radically resected hepatocellular carcinoma with distant metastases of the lung is reported. Two years after a complete removal of the primary liver malignoma a local recurrence was resected which was followed by selective intraarterial cytostatic treatment and chemoembolisation. A three-year disease-free interval was achieved, then recurrence in the liver and lung metastases were detected at the regular check-up. All of the malignant focuses were eliminated by parenchyma sparing surgical resections, then a postoperative adjuvant chemotherapy (FAM scheme) has been followed. After eight months the patient remained symptom-free. The long-term survival seems to justify the aggressive approach of this kind of malignancies.

Diffusion Approximation for Random Walks on Anisotropic Lattices

We show that the horizontal position of a random walk on a two-dimensional anisotropic lattice converges weakly to a diffusion process.

Internal carotid stent implantation with angioscopic control

Stent implantation is a method, which is being used more and more often, mainly in the field of peripheral arteries, but coronary stent implantation is also well-known. The authors apply this procedure for patients, who besides the carotid bifurcation stenosis also suffer from the internal carotid stenosis in a longer section of the artery. The indication are as follows: 1 in the case of internal carotid stenosis in a longer section we assure the flow with the help of carotid thrombendarterectomy and slove the run-off with balloon catheter dilatation and stent implantation. 2. in the case of a stenosis in a short section we use stent implantation to avoid dissection of the intima. With each intervention we perform the carotid bifurcation thrombendarterectomy. The authors made the first intervention 15 months ago, since then we have performed 17 stent implantations. One of the 17 patients developed a temporary stroke (TIA). This is a new method, further cases are needed for long-term experiences. Intervention under eye-control can be carried out with more confidence. As regards to the post-operative medicinal treatment, the administration of thrombocyte aggregation-blockers or heparinoid preparation (e.g.: PPS-SP 54) after the stent implantation has become a routine therapy. Summarized the foregoing, these cases constitute about 10-15% of all carotid operations, therefore the authors would like to make it clear, that this is not a routine method, but a possibility, strictly respecting the above-mentioned indications.

[Lifesaving thrombolysis--in the light of contraindications]

The authors review the different methodological suggestions concerning thrombolysis, especially from the aspects of the absolute and relative contraindications of the treatment. They present case reports to prove that in patients with life threatening thromboembolic diseases some points of contraindications may be disregarded. They suggest a new strategy of absolute and relative contraindications be made considering the currently available recently introduced thrombolytic therapy.

[The use of adenosine in the diagnosis and treatment of cardiac arrhythmias]

The authors investigated the effect of adenosine or ATP on narrow QRS tachycardia in 56 pts, 3 pts with wide QRS tachycardia 9 pts with suspected latent preexcitation and 10 pts with PVC suspected to be ventricular parasystole. After the bolus iv. administration of adenosine or ATP every SVT was stopped related to AV node (44 pts), but in the rest twelve related to atrial origin of SVT only one automatic atrial tachycardia could be stopped. From the 9 patient suspected to have concealed WPW 2 pts had delta wave during the effect of adenosine, and in four pts parasystole was demonstrated among the pts had varying coupling interval PVC. None of the pts who had wide QRS tachycardia was the tachycardia stopped, but in two cases the supraventricular origin--atrial flutter and tachycardia--was discovered. The authors emphasize the favourable effect of adenosine in narrow complex tachycardia and suggest that it can given safely in wide QRS tachycardia of unknown origin either. The diagnostic effect of adenosine can be used in sinus rhythm too if latent preexcitation or ventricular parasystole is suspected.

[Transient Q-waves in coronary disease]

The authors discuss the transient ischemic Q waves in various situations. Five cases are presented. Two patients had exercise-induced Q waves, one patient had right bundle branche block-dependent Q waves, one patient had transient Q waves after thrombolytic therapy and one patient had transient Q waves caused by Prinzmetal angina. Profound ischemia may not result in necrosis but may cause myocardial stunning. Myocardial stunning may be accompanied by deranged electrophysiologic activity with transient loss of electromotive forces.

Production of fish chimeras from embryonic cells

The efficiency of two cell-transplantation methods were compared for the production of embryonic cell derived fish chimeras. The classic microinjection technique (blastula stage donor cells are microinjected into blastula embryos) was compared to a novel aggregation method for fish developed by our group. This method utilises the ability of dechorionated fish embryos to aggregate. Morula cells dissociated in Ca2+, Mg2+ free medium were aggregated to recipient embryos of different developmental stage. Donor cells and recipient embryos of different developmental stages were used for most efficient incorporation in the chimeras. THe fate of donor cells derived from blastulae, was followed by labelling them with FITC-dextrane (FD). The most efficient transplantations were gained by using 16-32 cell stage recipients for aggregation (18% survival of chimeras at swim up stage). Labelled donor cells were contributing to the embryos in varying ratio. A comparison of the efficiency of aggregation was made between diploid-diploid, diploid-haploid and diploid-interspecfic (diploid) hybrid chimeras. In all three cases chimeras containing different proportion of donor cells were gained. After one day incubation the embryos were dissociated by trypsin digestion and number of labelled and non-labelled cells were counted under fluorescent microscope. Experiments were performed on Rosy barb (Barbus conchonius), Carp (Cyprinus carpio) and African catfish (Clarias gariepinus).