[RNA interference and molecular pathology of selected diseases]

Since many people all around the world are suffering from genetic disorders, modern therapeutic approaches are focused on the search of new pharmaceutical products. These products will be able to act on the gene level, more accurately on the nucleotide sequences themselves. RNA interference (RNAi) is an evolutionary conserved process that is caused by double stranded RNA (dsRNA). MicroRNA (miRNA) and small interfering RNA (siRNA) are the most important dsRNAs, which have been identified so far. Short (19-25 bp) non-coding dsRNAs are responsible for regulation of cellular development, heterochromatin formation and genomic stability in eukaryotes. Most importantly they are able to silence cognate genes. Therefore, they can provide new insights into the gene function and pathway analysis. Furthermore, they are believed to be new potential targets for diagnosis and therapeutics, especially for the treatment of genetic disorders, which can be caused by nucleotides insertions, deletions and translocations.

[Acute hemorrhage of the upper part of the gastrointestinal tract--survey of emergency endoscopy of the upper gastrointestinal tract at our facility]

INTRODUCTION

Acute upper gastrointestinal tract bleeding is a cause of significant morbidity and mortality and is a reason for urgent endoscopy. Besides an age and associated diseases, prognosis of patients influence also localisation and type of bleeding. The aim of our retrospective analysis was to discover causes of bleeding into upper GI tract and its characteristics over a 4 year period.

METHODOLOGY

A survey of urgent upper GI tract endoscopies in the Clinic of Internal Medicine in Motol in Prague because of an acute GI tract bleeding (hematemesis or melena) was done. Found ulcers were assessed using Forrest classification. Moreover, number and causes of recurrences of bleeding were also assessed.

RESULTS

Within years 1998-2001 an urgent upper GI endoscopy because of bleeding (hematemesis or melena) was done in the Clinic of Internal Medicine in Prague in Motol in 1639 patients of an average age 62.2. 56% were men (average age 59) and 44% were women (average age 65.3). An endoscopy finding without pathology was present in 21.4%. The most frequent sources of bleeding were ulcers in duodenal bulb (20%), stomach ulcers (18.2%), and hemorrhagic gastropathy (16.5%) and varices (10.3%). Results of the Forrest classification in the ulcerative disease of stomach and duodenum were as follows: Forrest Ia 9.5%, Ib 24%, IIa 14.6%, IIb 18.7%, IIc 22.9%, III 10.3%. Recurrent bleeding was identified in 8.4% of patients, thereof bleeding from esophageal varices experienced 2.9% of patients (average age 45.8), bleeding from ulcers in bulbus 2.7% (Forrest Ib, IIa a IIb) of patients of an average age 62.6, and bleeding from ulcers in stomach 2.1% (Forrest Ia, IIa a Ib) of patients of an average age 62.5. Causes of recurrent bleeding were in one case bleeding from Barrett's oesophageal ulcer and in one case bleeding from ulcer in diaphragmatic hernia. Within 48 hours recurrent bleeding appeared in 65% of patients.

CONCLUSION

Urgent endoscopy in gastrointestinal tract bleeding is an essential part of a complex medical care. It is highly reliable in identifying cause of bleeding, it enables to start treatment immediately and to consider prognosis of a patient.

[A new method of administering analgesic sedation before gastroscopy--a comparative study of 100 patients]

The authors administered to two groups (56 and 44) patients before gastroscopy analgosedation-5 mg diazepam and local anaesthesia of the throat. To the first group diazepam was administered by the i.v., to the second group by the sublingual route. The objective was to find out whether analgosedation is desirable from the patients aspect and whether the sublingual form of premedication is accepted by the patients. The authors found that 90% of the patients wish to have analgosedation and anaesthesia before the procedure. The sublingual form of administration was accepted by 89% of the patients.