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Objective: In organ allotransplantation represents a serious problem acute rejection, which is the reaction of recipient organism aimed to reject the transplanted organ., Aim: To obtain experience in the field of routine long term are of patients after heart transplantation living in Slovakia., Method: 33 patients after orthotopic heart transplantation (HTx) were included in our long term care by the 1. June 1996. According to the accepted protocol we make the whole set of examinations is performed. This includes endomyocardial biopsy which is the only reliable method for the detection of rejection and also the criterion of sufficiency of immunosuppressive therapy., Results: Acute rejection was revealed in 14 (43%) patients., Conclusions: Tactics of therapy and the length of the interval to subsequent biopsy were determined according to the histological findings of preceding biopsy, the clinical status and the combination of immunosuppression therapy. (Tab. 2, Ref. 13.)

Arrhythmogenic dysplasia of the right ventricle as a nosological entity was described relatively recently. However, at present, it is gradually being diagnosed more frequently. The authors describe the typical clinical picture of this disease in one of several patients with this disease, who were hospitalised at SUSCH. The authors describe the diagnostical value of individual findings. They indicate the importance of knowledge of individual diagnostical criteria in order to be able to recognize this disease and distinguish it from idiopathic ventricular tachycardia, the prognosis of which is generally better and also the therapeutical approach less aggressive. (Fig. 6, Ref. 29).

The authors present an account on contemporary knowledge of the diagnosis and differential diagnosis of fibrillar glomerulopathies. The latter are characterized by extracellular localized microfibrils and microtubules resp. in the glomeruli of the kidneys, their diameter being 8-60 nm. They are divided into amyloid and non-amyloid types. The others are classified according to the immunofluorescent finding into immunoglobulin positive and negative ones. The differential diagnosis is important in particular in immunoglobulin positive ones as they are present in serious diseases such as cryoglobulinaemia, monoclonal gammapathy, systemic lupus erythematosus and immunotactoid glomerulopathy.

The authors described aim. objectives, design and criteria of the study which is oriented to the clinical and research problems of heart diseases of uncertain origin. The paper presents the preliminary experience with invasive cardiological techniques in this field. At the same time the authors discuss the potential impact of the basic research on the prevention and effective treatment of cardiopathy which is until now of unknown origin.

The authors present epidemiological data about congestive heart failure, its most common etiology and prognosis. They justify the performance of heart transplantation (HTx) in the treatment of congestive heart failure. They analyze the present state of HTx in the world and describe also the history of HTx in Slovakia. They present the review of contraindications and indications for the inclusion of recipients into the HTx programme and describe the further fates of these patients. They regard the HTx as an integral component of the therapeutical approach to the precisely defined group of patients with otherwise refractory congestive heart failure. (Tab. 4, Fig. 6, Ref. 38.)

The authors present contemporary views on the pathogenesis, clinical picture and treatment of chronic renal failure. A comprehensive approach to the pathogenesis of renal failure revealed new therapeutic methods such as treatment with erythropoietin, vitamin D etc. The authors emphasize substantial changes in the quality and range of the clinical picture which developed due to the prolonged survival of patients with dialyzation treatment. New problems developed such as e.g. dialyzation amyloidosis, aluminium intoxication, endocrine changes, increased occurrence of malignities etc. These must be foreseen, diagnosed and treated. While during the first half of this century uraemia was a fatal disease, at the end of the nineties patients survive due to the dialyzation and transplantation programme.

Authors measured the thickness of the basement membranes of the proximal and distal tubuli in the renal cortex in 20 patients with verified diabetes mellitus. The test group consisted of 20 patients with small abnormalities of glomeruli (or in the range of variable norm), of the same sex and comparable age. Measurements were performed in locations without tubulo-interstitial changes. The average thickness of TBM in patients with diabetes mellitus was 1540 +/- 616 nm, and in the test group 360 +/- 86 nm, which is a statistically significant difference (p < 0.000000). In spite of the small number of cases and possible error in the manual measurement of electron microscopic pictures, a significant thickening of TBM in diabetes mellitus has been found. We consider this to be of diagnostic value.

Three sialic acid-specific lectins, Tritrichomonas mobilensis (TML) (without linkage preference), Maackia amurensis leukoagglutinin (MAL) (alpha2,3) and Sambucus nigra agglutinin (alpha2,6 linkage-specific), were used for detection of sialylated glycoconjugates in normal and diseased human kidneys. Normal kidneys demonstrated strong podocyte positivity of alpha2,3 linked sialic acid and weaker sialic acid expression on capillary endothelium, which was alpha2,6 linked. Renal biopsies (45) representing a variety of diseases, e.g. minimal change disease, membranous, membranoproliferative glomerulonephritis, tubulointerstitial nephrosis or diabetic glomerulopathy showed increased sialic acid expression in glomerular capillaries, Bowman's capsule epithelium and on podocytes. In several different kidney diseases the glomerular endothelium expressed also alpha2,3 linked sialic acid along with increased TML-positivity of epithelial cells related to alpha2,6 linked sialic acid. No difference in sialic acid linkage expression was observed in the tubules, which expressed putative alpha2,6 linked sialic acid on the luminal surface of cells distal to the descending limb of Henle's loop. The study did not show changes characteristic of specific diseases. Rather, increased sialic acid expression on glomerular endothelium and podocytes was linked to a variety of pathological changes. It is assumed that changes in sialysation of glycoconjugates in the glomeruli represent nonspecific changes and do not reflect fundamental pathogenetic features of renal diseases.

The authors describe four, out of 506 cases of renal biopsies in which this diagnostic procedure enabled to reveal a tumour. Two cases of tumours which were intentionally subdued to renal biopsy justified an angiomyolipoma and a focus (metastasis) of tubulopapillomatous carcinoma) in the kidney. In one case the renal biopsy revealed renal infiltration thus enabling to state the diagnosis of chronic lymphatic leukaemia subsequently, and in the last case where the diagnosis of chronic lymphatic leukaemia had been stated in advance, the renal biopsy was performed due to suspective glomerulonephritis. In these cases the unexpected results of renal biopsy were of great diagnostic value. Such intentional use of biopsy is rare. (Fig. 3, Ref. 6.)

On the basis of 506 renal biopsies performed within a six-year period (237 of which were evaluated electron-microscopically) the authors discovered that in 11 cases the diagnosis based on electron microscopic examination had to be corrected or supplemented by the diagnostic statement of membranous glomerulonephritis. These cases included 1 boy (HBsAg positive), 2 men and 8 women were middle aged. 5 women were treated due to polyarthritis. All cases when examined light-microscopically yielded a pattern evaluated as normal, or as minute abnormalities of glomeruli. Half-thick sections were not sufficient for the diagnosis. 3 cases of biopsies yielded a variously developed chronic tubulointerstitial nephritis, two cases were accompanied with polyarthritis. On the basis of the latter the authors consider the electron microscopic examination as indicated: 1. in cases when the diagnosis statement is not achieved by other examinations, 2. findings are in the range of the so-called variable norm, 3. in all cases of minute abnormalities in glomeruli detected without electron microscopy, 4. the impact of any of effective drugs cannot be excluded, 5. the diagnostic conclusion based on renal biopsy and the clinical-laboratory pattern of the disease are inconsistent. The authors assume that especially the fourth and fifth groups are going to be gradually supplemented and made more precise. (Fig. 1, Ref. 5.).

The authors described their experiences with endomyocardial biopsy (EMB) in 21 adult patients aged from 18 to 59 years with the preliminary diagnosis of cardiopathy of uncertain origin (CPUO). Their definition of CPUO is as symptoms and/or findings of cardiac disease, which cannot be exactly identify using even complex clinical and noninvasive cardiological diagnostic procedures. Diagnostic value of EMB was substantial in two of their patients (in one hypereosinophilia of myocardium, and in another amyloidosis), non specific results were found in 18 patients, and 1 patient had normal pattern of the biopsy. EMB is useful and safe clinical diagnostic procedure in exactly defined groups of patients.

The authors examined consecutive renal biopsies from 43 patients with minor glomerular abnormalities and from 35 patients with chronic tubulointerstitial nephritis (in the least affected glomeruli). The findings were evaluated according to WHO criteria of minor abnormalities. They found that significantly more frequently lipid drops were found in minor abnormalities (6:0), as well as changes in the capillaries of glomeruli (breakdown 1:7), wrinkling (15:29-highly significant even after correction of p)) in tubulointerstitial nephritis. The incidence in another 15 compared indicators there was not significantly different. With regard to the assembled results the authors consider the morphological finding of minor glomerular abnormalities as non-specific changes, and adaptational glomerular changes in response to various noxious substances. Therefore it is necessary to evaluate purely morphological findings of minor abnormalities carefully and in a differentiated manner, in particular in conjunction with treatment.

A group of patients younger than 40 years of age, who had been subdued to endoscopic large intestine adenoma polypectomy were compared with the rest of the patients regarding the adenoma occurrence according to sex, localisation, histologic character, frequency of recurrence, and carcinoma formation in the large intestine in the site of previous polypectomy. The compared groups of patients differed merely in time of recurrence. In patients over 40 years of age the adenomas reoccurred most frequently in the first and fifth years following the primary polypectomy. In patients after primary polypectomy regular colonoscopic controls were suggested, namely after the first year and subsequently after every two years. This scheme is appropriate also for patients under the age of 40 years. Therefore the recommended intervals of colonoscopic controls at this age category do not require to be subdued to alteration. (Tab. 14, Ref. 5.)

Among 1,499 representative renal biopsies in 278 cases nephrotic syndrome was diagnosed. In the latter only in 201 glomerulonephritis was confirmed by biopsy and in 77 (more than one quarter) the bioptic finding was different. The authors attempt to analyze the essential feature of nephrotic syndrome focused on the glomerular basal membrane and surrounding structures.

Further development of Czechoslovak pathology depends on the worldwide speed and direction of progress in pathology, on economical and political progress, and on transformation of the Czechoslovak health care system. Changing orientation of pathology in advanced countries predicts an increased importance of working qualities in the whole scope of pathologist. Intrinsic factors controlling progress in pathology are varied and can be partly influenced. Participation of pathology in the new system is to be actively prepared by mutual information and cooperation.

Personnel of 112 departments of pathology and 28 autopsy stations comprises 380.74 physicians, 30.63 academic non-physicians 761.43 medical technologists, 22.04 others with secondary school qualification, 267.45 autopsy aids and 205.18 others. In 1988 they performed 40,678 autopsies (53.47 per cent rate of hospital deaths), produced 548,854 necroptic slides, 1,902,707 bioptic slides, 559,709 cytologic slides, 46,955 semi-thin sections, 75,888 histochemical and immunochemical slides (total without necroptic slides represented 82.49 per cent). One physician could be calculated as related to 106.83 autopsies and 8,226.01 slides, one medical technologist to 4,118.41 slides. The proportion of physicians to other personnel was 1 to 3.38. Data from both national republics were quoted.

In a total of 1499 representative renal biopsies 30 displayed morphological changes suggesting diabetic nephropathy. Six patients had clinically diagnosed diabetes at the time of biopsy, 20 according to the bioptic finding, and in four patients the examination did not confirm diabetes. The authors describe the morphological vascular changes in particular the cumulation of masses resembling the mesangial matrix and basal membranes, as well as hyaline lesions, their development, site and combinations. In the author's opinion the most reliable sign of early diabetic nephropathy is thickening of the glomerular basal membrane. They draw attention to the non-specific character of the morphological finding and the necessity to diagnose diabetes mellitus by clinical and in particular by laboratory methods.

Authors presume following changes of present status: comeback of one-step board examination, possibility of a superspecialized board examination, varied short and long-term training courses, settling of detached training centres, problems of residential training as related to payed services, need of Medical Chamber supervision. Everything will depend on new legislation.

The authors evaluated the course and prognosis of the disease in 109 children with minor glomerular abnormalities manifested clinically in 45.9% as nephrotic syndrome (NS), in 33% as nephritic syndrome (GN), in 11.9% as isolated haematuria (IH) and in 9.2% as Schönlein-Henoch's purpura (PSH). In NS 78% of the children had before biopsy of the kidneys frequent relapses, 22% were resistant to cortisonoids. After biopsy all children were given cortisonoids, 94% immunosuppressive treatment with cytostatics and some of the children additional treatment. The number of resistant cases declined to 10% and the mean number of relapses from four to one in 12 months. Children under five years had more relapses (P less than 0.05) but also more complete remissions (P less than 0.001) than older children. Relapses occurred up to 10.2 years after the onset of the disease (mean = 4 years). With advancing age and duration of the disease their number declined after treatment. An adverse symptom was resistance to cortisonoids and immunosuppressive treatment, major haematuria and persisting hypertension but not immunological activity (elevated level of immune complexes, reduced C3, positive immunohistochemical finding in renal tissue). The morphological finding which at the onset was slightly beyond the range of minor abnormalities had a poorer prognosis when associated with greater clinical activity. The group developed 88% complete remissions and 6% CHRI. After 22 years the probability of survival in complete continual remission is 66%, the probability in CHRI is 10% (with morphological progression). In nephritic syndrome the children were given after biopsy prednisone in 80.6% and cytostatics in 44.4%. In PSH this treatment was given to 100% and 60% of the children, in IH to 61.5% and 7.7%. On evaluation in nephritic syndrome complete remission was recorded in 47.2%, after 0.4-10.5 years since the onset of the disease; 30.6% did not improve and in 2.8% CHRI developed. In PSH remission developed in 60% after 0.8-6.9 years, no improvement was recorded in 20%, incl. 10% where CHRI developed after a resistant course of NS. In IH 84.6% of the patients did not improve, but in none the renal function deteriorated. The course was in all instances milder than in NS, most frequently only with microscopic haematuria and/or slight proteinuria, respectively minor immunological activity. In the entire group of minor glomerular abnormalities complete remission was achieved in two-thirds of the children, in one quarter the disease did not improve, incl. 4.6% where CHRI developed, always associated with progression of morphological changes.(ABSTRACT TRUNCATED AT 400 WORDS)

The authors treated eight children with corticoid dependent syndrome caused by minor abnormalities of the glomeruli with Cyclosporin A. They administered Cyclosporin, 5 mg/kg/24 h., for a period of 8-16 weeks. In three patients they used Cyclosporin A alone, 5 children were given in addition 10 mg Prednisone per day. They achieved complete remission in all patients. During treatment they monitored haematological and biochemical parameters as well as Cyclosporin A levels; before treatment and after its termination they examined also immunological indicators. They did not observe any serious side effects of treatment.

A case of mixed hepatoblastoma in a 66-year-old man is discussed. Assessment of malignant mesenchymal and malignant epithelial elements yields the diagnosis. In the reported case, the epithelial area consisted of fetal hepatocytes. Distinct ductal differentiation, chondroid and even asteoid metaplasia were recorded. The morphological and immunohistochemical findings observed in the given patient are compared with data published in the world literature.

A series of 452 with 831 precancerous and tumorous lesions of the corpus uteri is presented. The series was obtained by analyzing the authors' own series of bioptic findings covering the period of two years. Some problems arising at the evaluation of proliferating myogenic and stromal precancerous and tumorous lesions are pointed out. "Classical" types of leiomyomas were found to be predominant, amounting to 78.5% of tumors recorded at the studied site. Of the total number of tumors of the corpus uteri, malignant tumors constituted only 8.5%. On evaluating the series of malignant tumors of the corpus uteri epithelial malignant tumors (94.3%) were overwhelmingly prevailing over sarcomatous tumors. Attention is called to problems of histological evaluation of prognosis of mesenchymal and mixed tumors. Literary data as well as the authors' own observations indicate the necessity of exact and particularly of differentiated histological evaluation of the described tumors.

Only one case of congenital nephrotic syndrome was recorded in a series of 2,500 bioptic examinations of the kidney performed over a period of 20 years. In necroptic material examined over the same period of time congenital nephrotic syndrome was recorded three times. At the first bioptic examination of the kidneys only minimal changes of glomeruli were diagnosed. Rebiopsy exhibited proliferation of mesangial cells, focal segmental glomerular sclerosis, cystically dilated tubules in the juxtamedular region of the cortex, and focal tubulointerstitial reactive changes, which in accordance with the clinical findings were assessed as congenital nephrotic syndrome of the Finnish type. Comparison of the findings observed at the first biopsy and at rebiopsy demonstrates the importance of proper collection of a representative sample for renal biopsy.

Spontaneous rupture of the parenchyma of the transplanted kidney occurs in 0.8 to 9.6 per cent of transplantations. Mortality is reported to be up to 9 per cent. Every rupture requires surgical intervention. In most cases graftectomy has to be performed. The cause of the rupture is an immunological destruction of the graft, the histological finding being a massive rejection of an interstitial type. In a set of 51 transplantations of cadaver kidneys rupture occurred in 4 patients (7.8 per cent). It was necessary to carry out a graftectomy in all cases immediately or later on.

In 70 patients with hepatocellular carcinoma without history of antineoplastic chemotherapeutic drugs, anabolic and contraceptive steroids, representative sections of nonneoplastic liver tissue were examined for the presence of etiological markers. Hepatitis B surface antigen-positive hepatocytes were found in 16 (22.8%), alpha-1-antitrypsin globules in 3 (4.2%), Mallory bodies in 9 (12.8%), acicular inclusions in 1 (1.4%), diffuse giant mitochondria in 2 (2.8%), copper-binding protein in 25 (35.7%), greater amount of hemosiderin in 9 (12.8%) cases. Thorotrast was not detected. One or more markers were seen in 38 (54.3%) cases, most frequently in association with liver cell dysplasia and alcoholism. The presence of hepatitis B surface antigen in livers with dysplastic foci was highly significant as compared to organs showing no dysplasia. Only the mentioned antigen and the alpha-1-antitrypsin globules were found to indicate the etiology of the underlying liver lesion. The value of the other markers was found inconsistent in etiological diagnosis.

The morphological picture of interstitial (tubulointerstitial) nephritis is not rare when renal biopsies or necropsies are evaluated. According to experience assembled during examinations of renal biopsies (a group of 1484 biopsies) in particular biopsies with morphological changes of the character of interstitial nephritis (144 in the group) and according to findings reported in the available literature, the authors submit an account of changes encountered in a large group of interstitial nephrites. The need of such an account ensues in particular from clinical practice where the morphological picture can be decisive for establishing the correct diagnosis in cases where other, in particular clinical and biochemical examination procedures, do not suffice.

To make a correct diagnosis of tubulointerstitial nephritis and to make it in time calls for knowledge of its clinical symptomatology (it is usually very marked in acute forms and in chronic forms it is frequently inapparent) and it is essential to know the main causes which produce this type of renal damage. In some instances the already developed disease is diagnosed and not infrequently even renal failure. Recognition of the aetiological and pathogenetic multiplicity of the disease, as made possible by the submitted classification of the WHO expert commission, is one of the prerequisites of the diagnosis and treatment in time or of prevention by effective provisions.

A group of 4495 autopsied patients was evaluated. In 1011 (22.5%) of them various malignancies were found. In 20 of these cancer patients (2%) also a nonbacterial verrucous endocarditis was observed. The most serious complication of this paraneoplastic syndrome was central arterial embolization resulting in cerebral and myocardial infarctions. In our group this was observed in 12 patients (60%), in 9 cases of them infarction was the immediate cause of death. Fatal complications due to central embolization were seen also in 3 patients who had a malignant disease without symptoms of generalization. The most frequent tumors observed among the autopsied patients were adenocarcinomas of the digestive tract (40%). In the group of revealed tumors adenocarcinomas clearly prevailed (70%) in 10 cases (50%) also mucin production could be detected.

A group of 157 children, 4-15 years old, suffering from various forms of glomerulonephritis were investigated. Associations between the HLA system and the clinical, morphological and therapeutic responses were looked for. The study revealed the following associations: chronic GN to B15 and B18; Schönlein-Henoch GN to B27, Bw35 and Bw40; focal GN to B18; mesangioproliferative GN to B27; susceptibility to corticosteroids to B18; resistance to corticosteroids to B15.

Two cases of colonic adenocarcinoma appearing 44 and 25 years, respectively, following an operation for urinary bladder exstrophy done according to Maydl are reported. A need for regular controls of patients with inner urine derivations has been emphasized. In the case of a suspected tumour it is necessary to alter the inner derivation to an outer one and also a resection of the colon at the site of the urinary bladder trigone is required. The Czech surgeon Karel Maydl was the first to implant the trigone of a splitted urinary bladder into the colon sigmoideum in 1892. This type of operation is used even today by several European urologists with excellent long-term results with respect to the preservation of an intact ureterovasical passage which prevents the reflux of the intestinal contents into the ureter, and also prevents the formation of strictures in the terminal parts of the ureter. In two patients who had been living for 25 and 44 years since they were operated on for urinary bladder exstrophy according to Maydl, a colonic adenocarcinoma was diagnosed. The tumour directly affected the implanted trigone wall and also involved the surrounding parts of the colon wall.