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The purpose of the study was to evaluate the effectiveness of the long-term oral pulse therapy with high doses of alphacalcidol (1 alpha (OH)D3) in severe uremic hyperparathyroidism. 43 hemodialysis patients with at least 5-fold 1-84 PTH serum elevation were given thrice a week oral (1 alpha (OH) D3) in doses up to 5 micrograms, according to serum calcium levels (monitored weekly). The drug was given in the evenings (Group A; 18 pts) or during hemodialysis sessions (Group B; 25 pts). The dialysate calcium was reduce to 1.40-1.45 mmol/l and CaCO3 was used as a main phosphate binder in doses up to 6 g/day; 13 pts received additionally small doses of Al (OH)3 (up to 3 g/day). After one month the PTH levels decreased by 67 +/- 7.7% (p0.001), while serum total calcium increased by 0.27or = 0.05 mmol/l. The parathyroid activity suppression progressed to 81 +/- 6.9% serum PTH reduction after 4 months and 74 +/- 6.1% fall after 8 months. Only 3 pts occurred to be non-responders; in 19 pts PTH levels normalized. A decrease of serum hydroxyproline and alkaline phosphatase with its bone isoenzyme activity was also observed with a direct correlation between those changes and parathyroid suppression. (1 alpha (OH) D3) dose at first month of therapy was 3.4 +/- 0.15 micrograms, but it was successively reduced because of hypercalcemia to a final dose of 2.2 +/- 0.22 micrograms. The frequency of hyperkalcemia was 7.6%; no difference between Group A and group B was noted. We conclude that oral (1 alpha (OH)D3) pulse therapy is very effective in the long-term parathyroid activity suppression in hemodialysis patients with severe hyperparathyroidism. To avoid dangerous hypercalcemia and relative hypoparathyroidism serum PTH and calcium levels should be carefully monitored.

Natural course of gastritis is far from being clarified. Having this fact in mind we undertook this study to establish how age and sex did influence the frequency and intensity of inflammation in particular stomach portions. Possible relation between gastritis on the one hand and cholelithiasis and idiopathic non-ulcer dyspepsia on the other was also checked. The study comprised 392 persons, including 148 subjects with cholelithiasis, 130 with non-ulcer dyspepsia and 114 healthy volunteers. Endoscopy of upper digestive tract was done in all of them, the specimens of mucosa of gastric antrum and body being taken for histologic examination. Frequency of gastritis was found to rise with age, particularly up to the 40-th year of life, being analogical in both sexes. In men, gastritis showed higher intensity and activity as well as more rapid progression toward glandular atrophy. In particular age intervals no significant difference in the frequency of gastritis was found between the population of healthy persons, that suffering from cholelithiasis as well as that with non-ulcer dyspepsia.

Background and Methods: That Helicobacter pylori has a role in the pathogenesis of gastric carcinoma is widely accepted, although not all doubts are definitively clarified. The purpose of this work was to detect the differences in presence and mean titer of anti-H. pylori antibodies between groups with gastric (n = 65), colonic (n = 70), and lung (n = 43) carcinoma.Results: The highest prevalence of anti-H. pylori antibodies was found in patients with pulmonary carcinoma (88.4%), which significantly surpassed (p = 0.02) that in the group with gastric carcinoma (69.2%). The groups with colonic and gastric carcinomas failed to show any difference in this respect. Mean antibody titer was significantly higher in subjects with lung carcinoma than in those with gastric carcinoma (p = 0.005). This difference was unrelated to age.Conclusions: These results contradict the hypothesis assuming a relationship between H. pylori infection and the sequence of phenomena leading to gastric carcinoma.

The aim of the study was to evaluate the efficacy of low molecular weight heparine (enoxaparin) in comparison to heparin during haemodialysis (HD) in prevention of blood clotting chestry extracorporeal circulation. Enoxaparin (Clexan, Rhone-Poulenc Rorer, in syringes, 20 mg) was evaluated in 42 patients with end stage renal failure treated with HD. In the first part of study heparine and in the second part enoxaparin given into arterial lines were evaluated during 6 following HD with the same type of dialysator. Clotting of extracorporeal circulation and bleeding time from the needle site after HD were evaluated. Activated partial thromboplastin time (APTT) before, after 1 hour of HD and after HD during heparine and enoxaparin were measured. There was advantage of enoxaparin in 23 patients when compared to heparine. It was depended on the reduction of number of injections of enoxaparin when compared to heparine (22 patients have received heparine in 2 or more doses when only 5 patients have received enoxaparin in 2 doses) on the reduction of clotting events in extracorporeal circulation (16 events during heparine treatment -6.3% of all HD and 5 events during enoxaparin treatment -2.0% of all HD), and on the shortening of the bleeding time from the needle site after HD (5.9 +/- 3.4 min. during heparin and 4.5 +/- 1.6 min. during enoxaparin treatment; p0.02). Increase of APTT after 1 hour of HD when compared to the value from before HD was significantly lower during enoxaparin than heparine therapy (1.73 +/- 0.4 and 2.55 +/- 0.91 respectively; p0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Standard therapy with orally administered active metabolites of vitamin D3 often does not satisfactorily control the biochemical manifestations of secondary hyperparathyroidism in uremic patients. This may be due to inadequate serum concentrations of 1,25 (OH)2D3 achieved during the treatment. Eighteen patients on chronic hemodialysis (HD) with severe hyperparathyroidism were given high doses of calcitriol (1,25 (OH)2D3) or alphacalcidol (1 alpha-OH-D3) orally, in ten evenings preceding each HD session. The effect of the treatment on circulating parathyroid hormone (PTH), serum hydroxyproline, serum alkaline phosphatase and bone isoenzyme was examined in a pilot study during 5 weeks. Irrespective the preparation given the treatment caused 71.7 +/- 22.2% reduction of intact serum PTH concentration with only moderate rise of serum calcium. A decrease of serum hydroxyproline and activity of alkaline phosphatase with its bone fraction, the direct indexes of bone turnover reduction, was also observed. With ongoing calcium carbonate therapy (3-6 g/day) 5 episodes of mild, asymptomatic hypercalcemia was observed for the 108 times of the total number of examinations; in those cases the dose of alphacalcidol was reduced. Our observations indicate that intermittent administration of 1,25 (OH)2D3 as well as 1 alpha-OH-D3 in high oral doses effectively suppress PTH synthesis in uremic hyperparathyroidism already in a couple of weeks. The effect is similar to that obtained with intravenous administration of the vitamin D3 active metabolites.

The aim of this study was to evaluate the clinical usefulness of the calcitonin test in predicting the hyperparathyroid bone disease severity in uremia. 200 IU of synthetic salmon calcitonin was given intranasally to 77 hemodialysed patients with end-stage renal failure. Before the test, serum calcium, PTH and serum alkaline phosphatase had been sampled; serum calcium was determined also in 2 to 4 hours after. The subjects were divided into 3 groups according to their serum PTH levels. Group I consisted of 24 patients with at least 10-fold serum PTH elevation, group II of 34 patients with intermediate values, and group III of 19 patients with serum PTH within normal range. In the group I the mean serum calcium fall was 0.32 +/- 0.16 mmol/l (1.28 +/- 0.64 mg/dl) (p0.001) and 0.27 +/- 0.15 mmol/l (1.08 +/- 0.60 mg/dl) (p0.001), after 2 to 4 hours respectively. In the group II serum calcium decreased by 0.16 +/- 0.12 mmol/l (0.64 +/- 0.48 mg/dl) after 2 hours and by 0.14 +/- 0.09 mmol/l (0.56 +/- 0.36 mg/dl) after 4 hours; the differences were statistically insignificant. In the group III no reduction in serum calcium was observed. In the whole 77 patients population significant linear correlations between the hypocalcemic response and iPTH as well as serum alkaline phosphatase were found. Our results confirm that the calcitonin-induced hypocalcemia a test can be, in addition to serum alkaline phosphatase and PTH evaluation, a simple and useful index of advanced hyperparathyroid bone disease in hemodialysed patients with chronic renal failure.

In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.

Twenty six clinically healthy smokers were studied with transient pattern visual-evoked potentials. In comparison with a sample of "normal" subjects we found a difference of some parameters (P less than 0.05): the P2-latency and the interocular difference of latency on average were 6-7 ms respectively 2 ms larger. Thirteen subjects have had a prolonged P2-latency (P less than 0.05) and/or a difference in interocular latencies larger than 5 ms. These findings may suggest on subclinical disturbances of visual system and indicators of an special sensitivity of that person. The findings are possibly related to tobacco-alcohol amblyopia.

The motor fitness was assessed in multiple sclerosis patients remaining in their homes in the City of Lódź. The age of the patients was up to 46 years; 5-6 years earlier they had been registered within one year in neurological health service institutions after variously long periods of the disease. The proportion of those with severe motor impairment was 14%, and it was highest (17%) in the groups with disease duration 10-14 years. Nearly half of the group, independently of the age, sex and disease duration, were patients who could move about and perform household works. The proportion of fully fit and nearly fully fit was highest (83%) among those whose disease began under the age of 20 years, and it was lowest (42%) in those with disease onset at the age of 20-29 years. A tendency was observed for a different development of motor function impairment in both sexes depending on the age, age at disease onset and disease duration. In the light of the obtained results it is estimated that in the population of cities in Poland in the whole group of multiple sclerosis patients or subjects with suspected multiple sclerosis registered within one year after variously long disease duration about 40-50% remain after 5-6 years still completely or nearly completely fit.

The "transit time to cortex" was estimated in the group of 15 patients living around the copperworks. The somatosensory evoked potentials method has been applied. Clinical and neurographic disturbances (polyneuropathy with prolonged sensory conduction velocity) in this group of patients was accompanied by disturbances of the central nervous system ("transit time to cortex" was prolonged). The examination of averaged evoked potentials has a great value in estimation of early stages of toxic damages of the central nervous system and can be applied in the prevention of chronic industrial poisonings.

The anthropologic examination comprised: somatic measurements, cephalic measurements, determination of the pigmentation of the eyes and hair of women with myasthenia. The studied group was living in the towns of Lower Silesia and it included 47 myasthenic women and 67 healthy ones aged from 24 to 45 years. In 36 patients the HLA antigens were determined. The examination showed significant differences in the proportions of the body and head and in the pigmentation of eyes and hair between both these groups. The haplotypes HLA-B8, HLA-DR3 and HLA-A1 were significantly more frequent in the group of patients.

Visual evoked potentials (VEP) were studied in 61 alcohol-dependent subjects analysing the amplitude and latency of the first major positive wave (P100) and carrying out the determinations three times, in the 1st, 2nd and 3rd weeks of abstinence. The results were compared with similar ones obtained in healthy subjects without a history of alcohol abuse. In the acute stage of alcohol withdrawal a significant rise was observed in the amplitude of the cortical P100/N120 complex. With regression of the clinical symptoms of withdrawal syndrome the amplitude of visual potentials decreased and demonstrated partial normalization. The mean P100 latency was significantly longer in relation to the control group and was not changed during the withdrawal period. Amplitude increase was regarded as an evidence of hyperexcitability of the central nervous system, and latency prolongation as a result of the toxic effects of alcohol and nicotine on the optic nerve.

Haemodialysis (HD) should affect the erythrocytes, which constitute more than 99% of blood cells. The aim of this study was to reinvestigate the intradialytic changes in erythrocyte water content (MCV). MCV was measured during 81 HD (47 uncomplicated, 34 with hypotension), and 16 isolated ultrafiltrations (UF) performed in stable, haemodialysed adults (12 males and 8 females). The MCV following uncomplicated HD (n = 32) did not differ from the predialysis value. Significant MCV increase accompanied the HD initiation (4.9 +/- 9.0 fl, P less than 0.001), UF (2.99 +/- 1.49 fl, P less than 0.001) and hypotension (1.8 +/- 3.1 fl, P less than 0.01). This was independent of sodium and potassium within the cells and plasma. Erythrocyte oedema occurred in situations known to accompany both bioincompatibility reactions and blood volume decrease. Intradialytic MCV increase may reflect a response to these events, possibly hormonal, and needs further investigation.