Differential collagen expression in kidney and heart during hypertension

AIM

The aim of the present study was to investigate the immunohistochemical expression of selected collagen types, namely collagen types I and V and procollagen type III in the renal parenchyma and interstitium and in the myocardium of spontaneously hypertensive rats.

MATERIAL AND METHODS

For the present study, we used two age groups of 6- and 12-month-old spontaneously hypertensive rats. An immunohistochemical analysis was conducted with monoclonal antibodies against collagen types I and V and procollagen type III. A semi-quantitative analysis of immunostaining intensity was conducted with the Image J software.

RESULTS

In the kidney, all three molecules showed higher expression at the age of 12 months, which was particularly notable for procollagen type III and collagen type V, which stained as highly-positive. In the myocardium, the immunoreactivity of collagen types I and V was stronger in 12-month-old animals, while that of procollagen type III did not change substantially.

CONCLUSION

The present study suggests a role of collagen types III and V in hypertensive kidney disease, while also establishing the role of increased expression of collagen types I and V in adverse myocardial remodeling (Tab. 1, Fig. 2, Ref. 48).

WILIS IRLE ARITINS, IMPORTANT FOR CEREBRAL PROTECTION IN AORTIC SURGERY - PRIMARY CT ANGIO DATA

Unilateral selective cerebral perfusion (SCP) is a method for cerebral protection in aortic arch surgery. However variations of the circle of Willis (CoW) could vitiate its protective effect. The aim of our present work was to make a retrospective analysis of 30 patients, in whom CT angio was performed between January and March 2008. Variations of Willis circle, which could compromise the perfusion during unilateral SCP were found in 21 patients (70%). We also found that many patients have significant stenosis of cerebral arteries. Our present study shows the need of extensive preoperative examination and meticulous intraoperative monitoring.

Survival role of superoxide dismutase 1 on human granulosa luteinized cells in vitro

OBJECTIVE

Deleterious effects of free radicals do not only result from the amount of free radicals produced but also are related to the efficiency and to the activities of enzymatic antioxidant systems. We investigated the effect of exogenous superoxide dismutase (SOD1) or Cu-chelating agent diethyldithiocarbamate (DDC) on the apoptosis (caspase-3 activity) of human granulosa luteinized cells (hGLC) in vitro.

METHODS

The effects of SOD1 and DDC were studied using in vitro culture system, caspase-3 and the total SOD activity in hGLCs were measured using AcDEVD-PNA substrate and Beaushap and Fridovich methods, respectively, after 48 h of the culture period.

RESULTS

The activity of SOD1 was the lowest in GLCs treated with 100 µM DDC as compared to control cells and to the cells supplemented with Cu, Zn-SOD or DDC (10 µM). The effect of DDC was associated with elevated caspase-3 activity as compared to control cells.

CONCLUSIONS

It was demonstrated for the first time that the supplementation of cultured hGLCs with Cu2+, Zn2+-SOD (200 U/ml) maintains the viability of hGLCs via caspase-3 suppression.

[Surgical treatment of left ventricular aneurysms--midterm results with two types of repair--linear resection and endoventricular repair]

OBJECTIVES

The optimal surgical technique for correction of left ventricular aneurysms is still debated. This study compares the midterm results achieved with linear resection or endoventricular repair.

METHODS

In the period February 2002-February 2004 forty-five consecutive patients with anterior LVA have been operated. The patients were divided in two groups according to the applied surgical technique--Group-I endoventricular repair in 23 pts (52%) and Group-II linear resection in 22 pts (47%). The mean age was in the whole group was 65.4 years, of them 34 (75.6%) were man, 41 (91%) were in NYHA class III or IV, 31 (68.8%) with congestive heart failure and 35 (77.7%) with stenocardia. Bypass grafting was performed in 41 (93.3%), trombectomy of the left ventricle 18 (40%), mitral valvuloplasty in 4 (8.8%) and VSD closure in 1 (2.2%) patients.

RESULTS

Early mortality was 8.6% in Group-I and 9% in Group-II. Low cardiac output treated with IABP and catecholamines was present in 13 (28.8%) patients and there was one ischemic stroke and one revision for bleeding. Important reduction in the ventricular volumes (56 ml) and in the functional class (from 3.2 to 1.3 NYHA) were observed. The reduction in EDVI and ESVI and the increase in EF were significantly higher in Group-I than in Group-II and a trend for future improvement in Group-I was observed at follow-up.

CONCLUSIONS

Both surgical techniques show similar good results in terms of mortality, improvement of functional capacity and survival. Endoventricular reconstruction shows advantages in volume reduction, increase of EF and reshaping of the left ventricle.

[Initial experience in endovascular treatment of abdominal aortic aneurysms in Bulgaria]

The abdominal aneurysm imposes prominent epidemiological impact due to its high incidence and life threatening complications. The first steps in endovascular treatment of abdominal aneurysms in Bulgaria are herein described. Five bifurcated and one straight stent-grafts were implanted in the ,,St.Ekaterina" University Hospital for the period from February till May 2004. Satisfactory therapeutic result was achieved in all cases. The continuing follow-up of the patients proved favorable tolerability. The good therapeutic response, lack of perioperative mortality, and low complication rate provide evidence that endovascular repair can have beneficial implication in patients with abdominal aneurysms and high operative risk.

[Surgical treatment of acquired mitral valve diseases--five-year analysis of early and late results]

The indications for mitral valve repair or mitral valve replacement are worldwide accepted, but they still depend of the personal experience of the surgeon and the tradition in the respective cardio-vascular clinic. Valve repair had many advantages over the replacement, but the long-term durability and the reoperations remain a major problem. In this retrospective review we examine the five years results of the surgical treatment of mitral valve diseases and the factors influencing the choice of the operation, the mortality and morbidity.

METHODS

From January 1998 to December 2002, 76 patients underwent mitral valve repair and 194 underwent mitral valve replacement. The mean age was 50.6 years, and 52.8% were NYHA class III or IV. The causes of mitral valve disease were ischemic in 45, rheumatic in 133, degenerative in 68 and endocarditis in 18 patients. Mitral valve repair was accomplished by Carpentier's techniques, Key, Alfeiri or ring implantation and mitral valve replacement with mechanical or biologic valve.

RESULTS

In the ischemic group early mortality occurred in 7 patients (15.5%), in endocarditis group in 3-16.6%, in degenerative group in 2 (2.9%) and in the rheumatic group in 3 (2.2%). Overall mortality in the replacement group was 5.1% and in the repair group (6.5%). Six patients needed reoperation in the repair (7.8%) and 12 patients in the replacement group (6.1%). Survival at 5 years was 90% in the repair and 83% in replacement patients.

CONCLUSIONS

Mitral valve repair are used almost always in ischemic and degenerative etiology, but they also show good results and long-term survival in cases of rheumatic mitral valve disease. The ischemic etiology, endocarditis and bad function of the left ventricle are the most important predictors for early death and poor long-term survival.

Our experience in the combined pathogenetic treatment of chronic glomerulonephritis

The most common combined pathogenetic treatment regimens for the treatment of chronic glomerulonephritis are the object of the present study. It is not quite uncommon in everyday clinical practice for the physician to encounter patients with similar pathohistologic patterns who respond differently to a standard therapeutic schedule.

METHODS

Having in mind the complexity of the problem we analyzed our ten-year experience with the combined pathogenetic treatment of 150 patients, aged 17 to 52, with histologically proven chronic glomerulonephritis. The diagnosis was made on the basis of light microscopy, immunofluorescent and, where available, electron microscopy studies of kidney biopsies using clinical and laboratory criteria. In most cases the combined pathogenetic treatment included standard dosage regimens consisting of corticosteroids--Prednisolone in a dose of 1.0-1.5 mg/kg, cytotoxic agents--Cyclophosphamide 1.0-1.5 mg/kg, anticoagulants--heparin (Calciparin) given for one month and antiplatelet drugs--Dipyridamole 300 mg/day. When the preceding regimen was unsuccessful the patients were given pulse therapy with Methylprednisolone 10-15 mg/kg on three successive days or Cyclophosphamide 10 mg/kg in a single dose. Those who failed to respond to the standard pathogenetic and pulse therapy were treated with Cyclosporin (Sandimmun-Sandoz) in a daily dose of 2-5 mg/kg. Complete remission occurred in forty-two patients (63.6%) with mesangial proliferative glomerulonephritis and 18 patients (60%) with membranous glomerulonephritis. The remaining patients were non-responders.

RESULTS

The highest percentage of patients with complete remission was observed among those with minimal-change glomerulonephritis--20 patients (95.2%) and the lowest--among those with mesangiocapillary glomerulonephritis--5 patients (27.7%), focal segmental glomerular sclerosis and hyalinosis and sclerosing glomerulonephritis--11.1% and 16.7%, respectively.

CONCLUSIONS

The authors think that at present the combined pathogenetic treatment of chronic glomerulonephritis has no alternative and can slow the progression of the renal injury as well as influence favorably the short- and long-term prognosis of the patient with glomerulonephritis.

Acute renal failure--etiologic and therapeutic considerations. A five-year experience at a single institution

In the present study we highlight the epidemiology, etiologic spectrum, and evaluation of ARF in adults. We then expand on the pathophysiologic mechanisms of renal failure and discuss the rationale for current therapeutic strategies in ARF patients. A total of 79 patients (45 male, female 34), aged 18-75 years (median age 51.2 +/- 17.7 years) with acute renal failure were studied in 5 years (January 1990 through October 1995). Emergency hemodialysis sessions following an acute anuric episode were instituted in 39 cases (49.3% of all patients). The median number of hemodialysis procedures per patient treated at our institution was 3.2 +/- 1.9. The total number of acute interstitial nephritis-associated ARF was 40. In 30 of them (75%) the acute renal insult included a combination of several therapeutic antimicrobial agents, in 2 cases (5%) ARF followed the administration of nonsteroidal anti-inflammatory drugs, in 1 (2.5%) it resulted from a combined therapeutic regimen and in the remaining 5 (12.5%) from the application of a single drug. Acute interstitial nephritis developed in 2 patients following a viral infection. In the hemodialysis-treated ARF group 12 patients (29.77%) had interstitial nephritis and 2 patients (5.13%) presented with renal impairment for an unspecified period of time preceding the development of overt ARF. In a subset of this group of patients, ARF occurred in 7 patients (17.95%) following an urologic intervention, in 8 patients (20.51%) as a consequence of thermal or mechanical trauma or intoxication and in 3 cases (7.69%) it resulted from fever of unknown origin. Three patients with postoperative peritonitis and 4 other (10.26%) with postoperative complications were encountered in our series. No cases of septic abortion-related or obstetric-related ARF were recorded. 92.3% of all hemodialysis-treated patients seen at our Institution had received a combination of antibiotics and only 2 patients had been pre-treated with a single antimicrobial agent. Our results underscore the strong tendency towards diversity in the etiologic spectrum of clinical entities causing ARF and the increase in the number of acute interstitial nephritis. These factors highlight the importance of precise dosing and administration of drugs, especially antibiotics, as well as the duration of antibiotic treatment.

Cyclic adenosine monophosphate (cAMP) levels in predialysis patients with chronic renal failure

We studied the changes in the urinary cAMP level in fifty-five predialysis patients (30 men and 25 women) with chronic renal failure (CRF). The excretion of cAMP in 20 patients with first-degree CRF (serum creatinine levels below 356.6 mmol/I) and 15 patients with second or third degree CRF (serum creatinine below 800 mmol/I) was compared with that of 20 age-matched controls using the original I-125 RIA (radioimmunoassay) kit of Incstar Corporation, USA. The urinary cAMP was within normal limits in first-degree CRF patients (mean +/- Sx = 2,617 +/- 268.2 nmol/l) whose serum calcium level was slightly decreased. When calculated per 100 ml of glomerular filtration rate, their urinary cAMP level was significantly elevated--101.17 +/- 0.39--as compared with that of the controls--2.5 +/- 0.2. The urinary cAMP excretion was significantly higher in second and third degree CRF patients--mean 3,755 +/- 435.2 nmol/l, p < 0.05. This increase correlated with hypocalcemia whereas the serum alkaline phosphatase levels remained normal. 20% of the patients with second or third degree CRF had normal urinary cAMP excretion. In our opinion, urinary cAMP levels can reliably be employed as a sensitive and specific indicator of the onset of mild secondary hyperparathyroidism in predialysis patients with CRF.