[Should sinus rhythm be restored in patients with chronic atrial fibrillation? Preliminary results from the Polish "Hot Cafe" study]

Atrial fibrillation (AF) is the most common arrhythmia occurring in clinical practice. It is the most frequent cause of hospitalization in cardiac rhythm disturbance. Despite comprehensive progress in the research into electrophysiological mechanisms leading to this loss of normal rhythm and new procedures dealing with it, the main problem being the conversion to and maintaining the normal sinus rhythm (SR) has not been solved. The polish study "Hot Cafe" is trying to evaluate the advantages and risks of the two procedures widely used in clinical practice in patients (pts) with chronic AF, i.e. conversion and maintaining SR vs leaving pts with the arrhythmia. Pts with non-valvular chronic AF fulfilling the criteria for including them into the sample are randomly assigned to two procedures: conversion to SR by means of direct current cardioversion and maintaining it or leaving pts with AF. Pts left with AF are treated by rate control and antithrombotic treatment. The project is of prospective kind and it will be carried out by many medical institutions. It is planned to include 200 pts. The observation period will last at least 12 months. Preliminary results after inclusion of the first 121 pts are shown.

[Pseudomembranous colitis in patients with kidney failure]

Two cases of pseudomembranous colitis in patients with renal failure are presented. Both patients were treated with antibiotics. Clinical course, bacteriologic examination of feces, and endoscopy of the colon plays an important role in the diagnosis of this complication. No gut endoscopy was performed in both patients due to severe disease course. Pseudomembranous colitis was diagnosed by clinical symptoms and bacteriologic examination of feces out of which C. difficile was isolated. Teicoplanin-a drug of a known efficiency in the treatment of C. difficile infection-was given and vancomycin was used in the second patient. We would like to stress that renal failure predisposes to the a development of pseudomembranous colitis. An emphasis is also on the dose adjustments of drugs in renal failure.

[Ultrasonic examination of the parathyroid glands, bone x-ray and calcium deposits of the eye in diagnosis of secondary hyperparathyroidism in light of 12 observed cases]

Twelve patients with chronic renal failure treated with repeated dialysis underwent subtotal parathyroidectomy. Histologic examination revealed hyperplasia parathyroidal adenoma in all patients. Diagnostic correlation between bone X-ray, ultrasound of parathyroid glands, calcium deposits in cornea and conjunctiva, and histological findings has been analysed. Radiological abnormalities have been noted in 8 patients (66%), parathyroid glands hyperplasia in 9 (75%), and corneal and conjunctival calcium deposits in 10 (83%) patients. These data confirm the value of techniques under study for the diagnosis of the secondary hyperparathyroidism in patients with chronic renal failure.

[Nephrotoxicity of aminoglycosides. III. Preventive studies with subcutaneous administration of converting enzyme inhibitor, captopril]

The effect was studied of the converting enzyme inhibitor (captopril) on the gentamicin nephrotoxicity in rats. Captopril 25 mg/kg b.w. and gentamicin 100 mg/kg b.w. were injected subcutaneously in a single daily dose. Three groups of Wistar male rats were studied: 1) treated with gentamicin 3 and 7 days, 2) treated with gentamicin and captopril, 3) treated with captopril. The mean serum creatinine and urea levels and proteinuria in the second group were significantly higher than in the first one. Light and electron microscopy examinations demonstrated increased renal cortex damage in the second group. There were not differences between mean urea and creatinine levels in the third examined group and normal rats. Mechanism of gentamicin nephrotoxicity enhancement in the second group is unknown.