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Intensity and severity of radiation-induced nausea and emesis depend on a number of factors including irradiation site, irradiation dose, treatment field (width and length), and age of the patients. Although less intensive than that induced by chemotherapy, during protracted courses of fractionated radiotherapy discomfort can be substantial. As early as 1953, Court-Brown [2] described characteristic symptoms after a single-fraction radiotherapy as "acute irradiation syndrome": irradiation was followed by asymptomatic period of 40-90 minutes, after that the patient experienced an acute episode of emesis, usually without preceding nausea. After a period of relative stabilization, additional episodes of emesis occurred for six hours after irradiation, decreasing its intensity with time. Danjoux et al. [5] noted a higher incidence of radiation-induced emesis after the upper half-body irradiation (UHBI) than after the lower half-body irradiation (LHBI), lack of efficacy of antiemetics administered, and similar response to emesis after the lower or the upper half-body irradiation. These results suggested that critical area was the upper abdomen. Although the exact mechanism of occurrence of radiation-induced emesis is still unknown, recent studies revealed that serotonin released from the gastrointestinal tract also produced emesis through mechanisms of involvement of 5-hydroxytriptamines (5-HT3) receptors, visceral afferent fibers and chemoreceptor trigger zone. We have, therefore, used a new 5-HT3 antagonist, ondansetron, in prevention of radiation-induced emesis in patients treated with single-fraction radiotherapy. ⋯ The results of this pilot study showed the excellent effect of the new 5-HT3 antagonist, ondansteron, in prevention of radiation-induced nausea and emesis. They confirmed results of the other authors [9, 10, 11] that used this antiemetic in the control of radiation-induced emesis. These studies included a variety of radiotherapeutic time-dose fractionation schedules, and some of them [11] included results of the total body irradiation. (ABSTRACT TRUN
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In patients with terminal renal failure treated by peritoneal dialysis diffusion and ultrafiltration are used for removal of substances from the blood. Neofiltration is realized via the osmolar gradient, determined by different concentration of glucose and dialysis solutions. Osmotic water transport during peritoneal dialysis is limited. ⋯ Today, 2500 lit of five types of solutions for hemodialysis are manufactured weekly at the Institute of Pharmacy. The quality of these solutions is secured by good manufacturing practise, quality control of substances and physico-chemical control of the produced solutions. The Institute of Pharmacy collaborates with the Clinic of Nephrology permanently improving and adjusting the production program.
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Chronic rejection of kidney transplant is a chronic and progressive decline of kidney transplant function related to certain morphologic changes, such as obliterate vasculopathy, interstitial fibrosis, tubular atrophy, and transplant glomerulopathy [1]. The purpose of this study was to investigate the involvement of chronic transplant glomerulopathy in the progression of chronic renal failure.
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Acute promyelocytic leukaemia (APL) is characterised by the morphology of bias cells (M3), t(15;17) translocation, and coagulopathy combining disseminated intravascular coagulation (DIC) and fibrinolysis. Anthracy cline-cytosine arabinoside (Ara C) intensive chemotherapy yields a complete remission in 50 percent (%) to 80% of newly diagnosed APL patients. Failure to achieve complete remission results in fatal bleeding due to coagulopathy or fatal sepsis during the phase of aplasia. It has been recently shown that all trans retinoic acid (ATRA) selectively differentiates abnormal promyelocytes into mature granulocytes in APL, both in vitro and in vivo, and induced complete remission in 80% to 90% of the newly diagnosed patients. It has also been observed that therapy with ATRA rapidly improved coagulopathy, and induced no aplasia. However, in 30% of patients the treatment with ATRA as a single drug was associated with rapid increase in leukocytes and signs of "ATRA syndrome", which could have fatal outcome. Therefore the European study group initiated in 1991 a multicentre randomised trial comparing chemotherapy with daunorubicin Ara C (chemotherapy group) and ATRA combined to the same chemotherapy (ATRA group) in newly diagnosed APL patients, aged 65 years or less. Results of this study strongly suggest that ATRA should be incorporated in the front line therapy of newly diagnosed APL. The aim of our study was to confirm their results in our newly diagnosed patients. ⋯ Our clinical trial shows for the first time in our county a beneficial effect of ATRA in addition to chemotherapy compared with chemotherapy alone in newly diagnosed APL, thus comfirming the results of the European study group. The only flaw of in our study may come from the fact that the patients included in the study were not randomised and that for the comparison of the ATRA group were used previously treated patients with chemotherapy alone. However, we believe that this flaw has been overcome since uniform diagnostic procedure and particularly MIC classification were performed in all patients. In addition to that, all patients included in the trial were subjected to the analysis of haemostatic status as well as to precise biochemical studies, ECG and abdominal echography. It is interesting to note that in our study, similarity to the European study group, 13% of patients developed "ATRA syndrome". Therefore, it is recommended that further effort should be made in order to prevent this fatal and not yet resolved syndrome.
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We present the facts on kind and frequency of disorder of high cortical functions in amyotrophic lateral sclerosis. It was considered for a long time that this disease affects selectively motor neurons. The signs of degeneration found in other structures and associated signs of other neurological disorders brought the diagnosis of amyotrophic lateral sclerosis under suspicion. ⋯ The nosological status of motor neuron disease with dementia is still controversial. There is a possibility of a new clinical entity or a variant of motor neuron disease. Taking into account the fact that pathological changes of motor neurons and the natural history of amyotrophic lateral sclerosis and amyotrophic lateral sclerosis with dementia are not essentially different, as well as the fact that frontal dysfunction is detected in non-demented patients with amyotrophic lateral sclerosis, the authors consider that we are facing a variant of well-known disease of motor neuron.