[Molecular biologic study and the factor VIII gene in hemophilia A]

Results of inversion in the intron 22 region of the VIII factor gene studied by Southern blot are presented. Inversion was found in 20 of 46 patients. In 14 cases (70%) distal and in 6 cases (30%) proximal type of inversion was detected. The significance of the positive result in genetic counseling and in presymptomatic diagnosis of Haemophilia A is emphasized.

[Availability of livers from cadaver donors in Hungary]

The availability of cadaver livers for transplantation have been studied based on data recorded prospectively by authors. Between January 1, 1995 and August 31, 1995, 98 cadaver kidney donors were accepted in Hungary. Using well established selection criteria 52 of them could have been suitable for liver donation. Steatosis or cirrhosis of the donor livers have been considered most frequent causes of unsuitability for transplantation. Based on these data 70-75 cadaver livers could be transplanted yearly in Hungary that's enough to start a transplant program. The treatment of acute hepatic failure with transplantation seems to be uncertain because of unequal time and blood group distribution of donors. There are just few available cadaver livers for children therefore transplantation of reduced sized liver is needed.

A proposal for introducing a modified vestibular index in neurotology. The classification of vestibular neuronitis

The parameters for vestibular dysfunction were modified after our own studies. This index includes the degree of vertigo present, spontaneous nystagmus, dysfunction of the vestibulospinal reflexes and caloric and postrotatory side differences. The index is applicable for defining the extent of a lesion, follow-up, defining its stage and the results of therapy. Introduction of the modified vestibular index is proposed for use in clinical diagnosis. Classification of vestibular neuronitis into groups A, B and C is suggested on the basis of the reversibility of spontaneous nystagmus after caloric stimulation.

[The effect of blood transfusion on the late results of the surgical treatment of rectal cancer]

Prospectively recorded data of 149 patients undergoing curative resection for rectal cancer between 1985-1992 were evaluated. Survival rate and tumor recurrence were studied in transfused and non-transfused groups of patients. There wasn't statistically significant difference found between the two groups concerning the 5 year survival rate (53 and 59%). Whole blood had more deleterious effect on survival than packed red cells (48 versus 61%), but the difference didn't reach the statistical significance level. The 5 year survival rate of patients without transfusion was significantly higher (p < 0.05) than those received > 800 ml of blood (59 v.s. 33%). The tumor recurrence wasn't associated with transfusion. Neither the quality, nor the amount of blood seems to influence on the recurrence rate significantly. In the group of patients with > 800 ml of transfusion the lower preoperative hematocrit, the higher rate of abdominoperineal resection of the rectum and the longer duration of surgery than those of patients nontransfused reflect the unfavorable tumor stage and the difficulties in removing the tumor. Authors believe these circumstances necessitating the transfusion may be responsible for worse outcome of rectal cancer but the immunosuppressive effect of the blood can't be excluded.

CONCLUSIONS

stricter indication than earlier is necessary for administration of blood transfusion to patients with rectal cancer to decrease the risk of transfusion-transmitted infections and to avoid the possible immunosuppressive effect of the blood. Packed red cells is preferable. Decreasing volume of perioperative homologous transfusion by improving surgical technique and clinical application of autologous transfusion should be considered.

The results of 1009 kidney transplantations performed in Hungary

Kidney transplantation is a widely used method throughout the world for the treatment of end-stage renal disease. Following the pioneering work of Szeged Medical University Hospital and Miskolc District General Hospital, the first successful kidney transplantation in Hungary was performed at the Department of Transplantation and Surgery at Semmelweis Medical University on November 16, 1973. This patient is still alive with a functioning kidney graft after 21 years. We report herein our review of the global results of Hungarian kidney transplantation. Hungary is a medium-developed country with a population of over 10 million where the gross national product is about 4000 U.S. dollars per person per year. In Hungary there are 49 dialysis centers, 4 immunological laboratories, and 4 transplantation centers.

[Water intoxication in pulmonary tuberculosis complicated by aspergillosis]

The authors found a serum sodium level of 113 mmol/l in a 70 year old confused male patient with cachexia and fever, which level rised to 125 mmol/l as a result of hypertonic sodium chloride and furosemide therapy, resulting in improving sensorium. At the same time the urine osmolality (235 mOsm/kg) was high compared to the serum osmolality (258 mOsm/kg). The physical and radiological examination showed bilateral pneumonia. The patient died in acute circulatory insufficiency. At the autopsy miliary pulmonary tuberculosis with superinfection by aspergillosis was proved. The authors discuss the possible mechanisms of water intoxication occurring with lung diseases and the difficulties regarding the diagnosis and therapy of aspergillosis.

[Fluorescence in situ hybridization in prenatal diagnosis. First experiences]

The authors examined the potential use of non-radioactive in situ hybridization in prenatal screening. Probes for chromosomes 18, 13/21, 21 and X were applied on fourteen samples of peripheral lymphocytes and nine samples of chorionic villi. The aim of the study was to compare the analyzability of the two different DNA probes for chromosome 21 on six samples of chorionic villi. Six of the nine samples of chorionic villi were hybridized with probes specific for chromosome 21 and all six cases were diagnosed properly. However, we need more data to establish a screening protocol for routine prenatal cytogenetics.

[The role of local excision in the surgical treatment of rectal cancer]

Between 1984 and 1992 authors performed 307 surgical interventions for patients with rectal cancer, of these 199 operations were curative (65%). Local excision of the tumour was carried out in 9 cases: 2 with palliative intent, 7 were considered a curative treatment, that constituted 3.5% of all curative procedures. Five tumours were removed by transanal local excision, 2 located in the upper part of the rectum required laparotomy and rectotomy. No operative mortality. One wound sepsis was registered after laparotomy. There was one local recurrence after removing the primary tumour. At the same time 83 patients suffering abdominoperineal resection or anterior resection had tumour limited to the rectal wall without lymph node metastasis. The mortality was 1.4%, the morbidity 28% and local recurrence rate was 19% in this group. The difference between the the results of the two groups did not achieve statistical significance included the survival too. Of the 83 tumours removed by more radical operations 38 located between 1-8 cm from the anal verge. Excluding tumours poorly differentiated and those with diameter larger than 3 cm, 17 rectal cancer would have been suitable for transanal local excision, that constitutes 8.5% of the curative operations.

CONCLUSION

with more accurate preoperative staging the transanal local excision for carcinoma of the rectum can be performed more frequently than earlier. The risk of the operation is lower than those of the abdominoperineal or anterior resection and the late results are comparable if strict selection criteria are implemented.

Expression of an adhesion molecule and homing in B-cell chronic lymphocytic leukaemia: I. Application of the HEV-binding assay to a clinical series

High endothelial venule (HEV)-binding of peripheral blood mononuclear cells (PBMCs) from 43 patients with B-cell chronic lymphocytic leukaemia (B-CLL) was investigated with a HEV-binding in vitro assay. Immunophenotyping of HEV-adherent PBMCs proved that most of them belonged to the B-cell proliferation. B-CLL cells stringently expressed CD44 molecules (Hermes-1, -3 and H90). The patients were subgrouped according to Binet's classification, as well as according to the organ manifestations, i.e. patients with B-cell monoclonal lymphocytosis of undetermined significance (B-MLUS) and patients with lymphocytosis (LY), lymph node enlargement (LN) and splenomegaly (SM). The HEV-binding activity of the cells was the highest in Binet stage A patients and in patients with B-MLUS (p < 0.05 in B-MLUS versus B-CLL LY, LN, SM). Based on these findings it is suggested that B-CLL patients show not only a clinical and immunophenotypical heterogeneity, but a diverse function of adhesion molecules.

[Growth inhibition of intraocular proliferative explants under in vitro conditions by verapamil]

BACKGROUND

For the treatment of non neoplastic proliferations in the fundus, a nontoxic, proliferation-inhibiting long-term therapy would be desirable in addition to vitreoretinal surgery. In theory, the use of calcium channel blockers as a means of prevention appears promising.

METHODS

In order to test the action of Verapamil in the above application, 42 preretinal, epiretinal and subretinal membranes were removed during pars plana vitrectomy between May, 1991 and June, 1992. Following crushing, these were cultured under cell culture conditions.

RESULTS

Cell division outside the membranes was seen in 27 cases. In 13 cases the minimum cell count was approximately 1000 per primary culture. Subcultures were prepared from each of the latter, the cells having been divided into four portions. Two of the samples were diluted with Verapamil in a concentration of 0.25 microgram/ml. When cell fusion began, the number of intact cells in each sample was determined. Verapamil inhibited growth significantly (significance level of 0.93, P < 0.01).

CONCLUSIONS

A larger number of cases would have to be studied to permit more comprehensive conclusions.

A computer controlled system for multiple site microcirculatory measurements

A system has been developed for intravital microscopy studies that records optical signals at different tissue sites together with X-Y coordinates within an area of up to 100 cm2. Z axis coordinates can also be recorded. The system utilizes a computer and a motor-driven microscope stage to rapidly and repetitively move between selected sites. The system can also be used to map topological features and geometry. The application of the system to study spatial heterogeneity of changes in tissue metabolism with time and to map vascular network architecture is described.

[Results of prenatal cytogenetic screening at the Prenatal Genetic Center of the Postgraduate Medical University between 1980-1990]

Evaluation of prenatal cytogenetic diagnosis by Genetic Center of Postgraduate Medical University in 1980 and 1990. Between 1980 and 1990, 1039 amniocenteses (AC), 1263 chorionic villus samples (CVS), and 30 fetal blood sampling were performed for cytogenetic reasons. The rate of chromosome abnormalities were 5.5 per cent in the first trimester CVS, 5.2 per cent in the second trimester CVS, and 3.1 per cent in AC. The Down syndrome was the most frequent abnormality (46 fetuses) and the next was the Edwards syndrome (15 cases). It was established that though the case number is fourteen times more than the beginning of this decade, this was enough only for screening women 39 or over. During this period several new methods were introduced making possible the diagnosis from 9th week of pregnancy until term. Among these methods the CVS has not only become an alternative to the AC but now it is the most frequent procedure in our laboratory. Though most pregnants are still referred for prenatal cytogenetic investigation because of their advanced age, the authors search for other risk factors which would make possible screening in younger women, too.

Malignant tumours after renal transplantation

The incidence of malignant tumours in 570 patients with kidney transplants was examined. It was found to be 20-30 times higher than in the average (normal) population. In accordance with the literature, mainly skin cancers were observed, but at variance with these data, the number of lymphoreticular malignancies was small. On the basis of their study, the authors emphasize the oncogenetic effect of immunosuppression. By comparing the conventional (AZA+PRED) and Cyclosporine (CYA+PRED) treatments, they point out that this risk should be taken into consideration even in Cyclosporine therapy which has otherwise a much more favourable effect.

Tetraploidy in human placenta. A dilemma in molar and non-molar pregnancies

17 cases of partial molar pregnancy were analysed cytogenetically by the direct-preparation method. Eight partial moles were triploid, 7 diploid/tetraploid mosaic, and 2 tetraploid. In the course of prenatal cytogenetic screening, out of 1,263 chorionic villus samplings, 2 tetraploid and 1 diploid/tetraploid cases were found. These cases of partial moles do not fit into the usual patterns of triploid partial moles. The findings presented here suggest that different causative factors may be involved in the origin of molar degenerations. These results also call to attention that tetraploidy is an existent and relatively common abnormality.

[Transabdominal chorion aspiration in the second pregnancy trimester]

The authors report their experiences with 377 transabdominal chorionic villi samplings performed in the second trimester of pregnancy, between 1987-1989. They used the double needle technique with continuous ultrasound guidance. In every case they could get a sufficient amount of villi from one puncture, and there was no unsuccessful direct chromosome-preparation. The obstetrical complications of the procedure were measured by the analysis of the outcome of the first 300 pregnancies intended to continue: the abortion rate after the transabdominal chorionic villi sampling seems to be lower, than after amniocentesis.

[Fetal diagnosis of Edwards syndrome]

Eight cases of Edward's syndrome were found prenatally by cytogenetical analysis of 1680 pregnant women. It has been estimated that after Down's syndrome Edwards's syndrome is the most frequently encountered chromosomal abnormality. This syndrome is associated with high rate of anomalies detectable by ultrasound (e.g. omphalocele, polyhydramnion, growth retardation). Here it is discussed in relation with sonographical findings related to Edwards's syndrome and representing clear indications for chromosomal analysis. The authors call attention to the importance of the diagnosis of Edward's syndrome at each gestational age.

[Effect of physical training on children after reconstructive heart surgery]

The authors composed a programme of physical training for children with congenital valvular defect. The training programme was applied before and after the heart operation. Two years after a successful reconstructive heart operation the fitness condition of 40 children was examined. The average age of the children was 8.0 +/- 3.6 years. Twenty of the children participated and 20 did not participate in the programme. The physical condition of the children who took part in the training was found to be significantly better than that of the others without training.

[Prognostic factors affecting survival in multiple myeloma]

70 patients suffering from multiple myeloma were observed by authors in the last 15 years and three months. In the meantime fifty-two out of them have died, and 18 patients are under permanent care. 43 IgG, 17 IgA, 6 Bence-Jones, 2 IgD types were diagnosed according to the paraprotein distribution, one patient proved to be nonsecretory, and an other one to osteosclerotic form as well. The median survival time was 27 months in the group of deceased patients. In the group followed-up 50.8 months survival time was observed up to the closing of the study. Several prognostic factors were investigated. According to the classification by Durie and Salmon the survival time was 60 months in the patients with stage I, 33 months in stage II., and 9 months in stage III respectively. The prognosis is much poorer in patients into the "B" category: the survival time was 14 months. Classified in the basis of the type of the myeloma-cell, the cases with well matured cells have had the best prognosis with survival time of 46 months, while the most unfavourable prognosis was observed in patients with blast-cell type, with a median survival time of 10 months. The greatest number of patients suffered from multiple myeloma of IgG paraprotein type, in this group the serum IgA level was found to be significantly decreased in the patients died due to inevitable infections. The survival was injured significantly by the occurrence of concomitant severe diseases, to.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cryptosporidium as a co-pathogen in infantile diarrhea and pneumonia]

The authors describe a case of cryptosporidiosis in a 10 month old immunocompetent infant, who suffered from prolonged diarrhoea and pneumonia. Cryptosporidium oocysts, Giardia lamblia were detected by using modified Kinyoun stain, and klebsiella was identified in the stool culture. According to the clinical presentation and the laboratory data the streptococcus infection is presumed as cause of the pneumonia, but the authors could not exclude the role of cryptosporidium in predisposing and/or causing the pneumonia.

[Discoid lupus erythematosus beginning on the eyelids]

We report on a 20-year-old women, who suffered from discoid lupus erythematosus (DLE) beginning on her eyelids with dyschromia and cutaneous infiltration. Similar signs appeared on the top of her nose, her nostrils, and her lower lip. Simultaneously with these alterations, we found a superficial exulceration on her hard palate, which histologically proved typical for DLE. After therapy with chloroquine for 3 weeks, the alterations disappeared.

[Prognostic role of immunoglobulin levels in chronic B cell lymphoid leukemia]

The authors analyse the prognostic role of the immunoglobulins detected in the sera of 83 patients with B-cell chronic lymphocytic leukaemia. They have found, that the decreased level of IgG, IgA and IgM itself has no significant prognostic role. In those cases, where the IgA level was the lowest at the recognition of the disease, the expected life-span was significantly shorter. As far as the immunoglobulin level and the clinical stage did not show any significant correspondence, the relative reduction of the IgA level at the recognition of the disease can be considered as a poor prognostic sign.