Martin Matějovič

Fever of unknown origin: A value of 18F-FDG-PET/CT with integrated full diagnostic isotropic CT imaging

AIM The aim of presented work is to evaluate the clinical value of (18)F-FDG-PET/CT in patients with fever of unknown origin (FUO) and to compare PET/CT finding with the results of the following investigation. MATERIAL AND METHOD 48 patients (24 men, 24 women, mean age 57.6 years with range 15-89 years) underwent (18)F-FDG-PET/CT due to the fever of unknown origin. All examinations were performed using complex PET/CT protocol combined PET and whole diagnostic contrast enhanced CT with sub-millimeter spatial resolution (except patient with history of iodine hypersensitivity or sever renal impairment). CT data contained diagnostic images reconstructed with soft tissue and high-resolution algorithm. PET/CT finding were compared with results of biopsies, immunology, microbiology or autopsy. RESULTS The cause of FUO was explained according to the PET/CT findings and followed investigations in 44 of 48 cases-18 cases of microbial infections, nine cases of autoimmune inflammations, four cases of non-infectious granulomatous diseases, eight cases of malignancies and five cases of proved immunity disorders were found. In 46 cases, the PET/CT interpretation was correct. Only in one case, the cause was overlooked and the uptake in atherosclerotic changes of arteries was misinterpreted as vasculitis in the other. The reached sensitivity was 97% (43/44), and specificity 75% (3/4) respectively. CONCLUSION In patients with fever of unknown origin, (18)F-FDG-PET/CT might enable the detection of its cause.

Pulmonary imaging using dual-energy CT, a role of the assessment of iodine and air distribution.

AIM The aim of the study is to present the feasibility of using dual-energy CT and the evaluation of iodine and air distribution in differentiation of pathological conditions. MATERIAL AND METHOD We used the data of 50 CT examinations performed due to suspected pulmonary embolism with any pathological finding except consolidation of the parenchyma. The patients underwent CT angiography of the pulmonary arteries on a dual-source CT (DSCT), with the two tubes independently operated at 140 and 80 kV. By exploiting the dual-energy information, iodine distribution maps were obtained in addition to the conventional CT images which served as a marker of pulmonary perfusion. Minimum intensity projections (MinIP) were used as a marker of air content. RESULTS By comparing the iodine distribution maps and MinIP images, it was possible to differentiate between the following templates of lung parenchyma: A--normal iodine and air distribution; B--iodine content deficit with minimal or with no redistribution of air; C--reduced iodine content and increased content of air; D--deficit of iodine content and increased content of air; E--increased iodine content and normal content of air; F--increased iodine content and reduced content of air; G--reduced perfusion and reduced content of air. The type A (five cases) was typical for the pulmonary embolism with preserved normal conditions of perfusion and ventilation. Type B (18 cases) occurred in pulmonary embolism; type C was found in case of inflammation of small respiratory airways (five cases); emphysema was typical for type D (nine cases); increased perfusion was observed in the parenchyma preserved from emphysema or preserved from embolism in cases of emphysema or pulmonary embolism; type F occurred in pulmonary interstitial edema (four cases) both with pulmonary infection; finally type G was found in interstitial lung diseases (five cases). CONCLUSION Imaging of the pulmonary circulation by means of dual-energy CT opens the potential to study pathological changes of circulatory and pulmonary perfusion impairments, our presented work signs the important relations between iodine and air distribution which have to be thought in the interpretation of dual-energy perfusion imaging of the lungs.

Continuous venovenous hemodiafiltration (CWHDF) with citrate anticoagulation in the treatment of a patient with acute renal failure, hypercalcemia, and thrombocytopenia

A 72-year-old patient with multiple myeloma was admitted to the intensive care unit because of hypercalcemic crisis and acute renal failure. After 7 days of comprehensive therapy including diuretics, steroids, calcitonin, and intermittent hemodialysis (IHD) with low-calcium dialysate, calcium still reached high levels between IHD treatments and thrombocytopenia developed after chemotherapy. CWHDF with calcium-free bicarbonate dialysate was started. Anticoagulation with 2.2 % citrate was performed in order to chelate calcium, and thus treat the hypercalcemia, and to provide regional anticoagulation, and thus reduce the risk of bleeding due to thrombocytopenia. CWHDF with citrate anticoagulation was continued for 6 days, and standard heparin anticoagulation was started when the hypercalcemia and thrombocytopenia abated.

Effect of rosuvastatin therapy on troponin I release following percutaneous coronary intervention in nonemergency patients (from the TIP 3 study).

Several randomized studies have suggested that pretreatment with statins may reduce a periprocedural biomarker release in patients who underwent percutaneous coronary intervention (PCI); however, results remain controversial. The purpose of this study was to investigate the effect of a 1-day rosuvastatin therapy on troponin I release in patients who underwent nonemergency PCI. A total of 445 patients with angina pectoris were randomly assigned to therapy with rosuvastatin (20 mg 12 hours before coronary angiography + 20 mg immediately before PCI; rosuvastatin group, 220 patients) or PCI without statin therapy (control group, 225 patients). In patients taking statins (73%), rosuvastatin was added to their long-term statin therapy. The primary end point was the incidence of TnI microleak defined as TnI elevation >1.5× upper limit of normal, and the secondary end point was the incidence of post-PCI TnI elevation >3× upper limit of normal. The incidence of primary and secondary end point in the rosuvastatin versus control group was 13.6% versus 12% (p = 0.61) and 8.2% versus 7.1% (p = 0.67), respectively. Patients with C-reactive protein ≥2.0 mg/L had a decreased release of post-PCI TnI in the rosuvastatin group (0.032 [0.010 to 0.143] μg/L vs 0.056 [0.018 to 0.241] μg/L; p = 0.04). In conclusion, 1-day rosuvastatin therapy (20 mg twice a day) did not influence post-PCI TnI release in patients with angina. However, these results suggest that, in patients with an advanced inflammatory status, rosuvastatin loading therapy might have a cardioprotective effect.

Plasma and Tissue Levels of Neuropeptide Y in Experimental Septic Shock: Relation to Hemodynamics, Inflammation, Oxidative Stress, and Hemofiltration

Neuropeptide Y (NPY), a potent vasoconstrictor released from the sympathetic nerves, has been suggested to counterbalance sepsis-induced vasodilation. Thus, the changes in plasma and tissue NPY concentrations in relation to hemodynamic variables and inflammatory markers in a porcine model of moderate septic shock were investigated. Susceptibility of NPY to be removed by continuous hemofiltration in two settings has been also studied. Thirty-four domestic pigs were divided into five groups: (i) control group; (ii) control group with conventional hemofiltration; (iii) septic group; (iv) septic group with conventional hemofiltration; and (v) septic group with high-volume hemofiltration. Sepsis induced by fecal peritonitis continued for 22 h. Hemofiltration was applied for the last 10 h. Hemodynamic and inflammatory parameters (heart rate, mean arterial pressure, cardiac output, systemic vascular resistance, plasma concentrations of tumor necrosis factor-α, interleukin-6, and NPY) were measured before and at 12 and 22 h of peritonitis. NPY tissue levels were determined in the left ventricle and mesenteric and coronary arteries. Sepsis induced long-lasting increases in the systemic NPY levels without affecting its tissue concentrations. Continuous hemofiltration at any dose did not reduce sepsis-induced elevations in NPY plasma concentrations, nor did it affect the peptide tissue levels. The increases in NPY systemic levels were significantly correlated with changes in the systemic vascular resistance. The results support the hypothesis of NPY implication in the regulation of the vascular resistance under septic conditions and indicate that NPY clearance rate during hemofiltration does not exceed the capacity of perivascular nerves to release it.

Mesenchymal Stem Cells in Sepsis and Associated Organ Dysfunction: A Promising Future or Blind Alley?

Sepsis, newly defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, is the most common cause of death in ICUs and one of the principal causes of death worldwide. Although substantial progress has been made in the understanding of fundamental mechanisms of sepsis, translation of these advances into clinically effective therapies has been disappointing. Given the extreme complexity of sepsis pathogenesis, the paradigm “one disease, one drug” is obviously flawed and combinations of multiple targets that involve early immunomodulation and cellular protection are needed. In this context, the immune-reprogramming properties of cell-based therapy using mesenchymal stem cells (MSC) represent an emerging therapeutic strategy in sepsis and associated organ dysfunction. This article provides an update of the current knowledge regarding MSC in preclinical models of sepsis and sepsis-induced acute kidney injury. Recommendations for further translational research in this field are discussed.

Plasma proteome profiling of von Hippel-Lindau disease after total and subtotal nephrectomy: A preliminary study

OBJECTIVES Common treatment of renal cell carcinoma associated with von Hippel-Lindau (VHL) disease is total (bilateral) or subtotal nephrectomy. Whereas total nephrectomy is associated with absolutely no residual renal function, subtotal nephrectomy frequently leads to chronic kidney disease (CKD) with some residual renal functions. However, molecular mechanisms underlying CKD remain unclear and the diagnosis of CKD is frequently accomplished at its late stage. DESIGN AND METHODS We performed a plasma proteomics study to compare the plasma proteome profile of VHL patient who underwent total nephrectomy to the profiles of VHL patient with subtotal nephrectomy and healthy control. Totally 100 mug proteins from each sample was resolved by two-dimensional electrophoresis (2-DE) in triplicate and visualized with SYPRO Ruby fluorescence stain. RESULTS The normal plasma proteome profile markedly differed from the profiles of VHL patients. Comparative analysis between total versus subtotal nephrectomized patients revealed significant differences in levels of 20 plasma proteins. Pathway analysis revealed two important networks involving in lipid metabolism, molecular transport, carbohydrate metabolism, cellular growth and proliferation, and small molecule biochemistry, in which these identified and other proteins interplayed. CONCLUSIONS Our data identified potential biomarkers for CKD. Further characterization of these identified proteins might also lead to better understanding of molecular mechanisms underlying CKD.