Electronic Library of Scientific Literature


Rheumatologia



Volume IX / 1995 Number 2

ASOCIACIA MEDZI DIFUZNOU IDIOPATICKOU SKELETALNOU HYPEROSTOZOU A ANTIGENOM HLA-B27 V SLOVENSKEJ POPULACII

ASSOCIATION BETWEEN DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS AND HLA-B27 ANTIGEN IN SLOVAK POPULATION

V. BOSAK, D. ZLNAY

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Asociacia medzi difuznou idiopatickou skeletalnou hyperostozou (DISH) a antigenom HLA-B27 je stale predmetom diskusie, pretoze sa zistila len v styroch studiach, medzi nimi aj v slovenskej populacii. Cielom prezentovanej prace je, vzhladom na pretrvavajuce rozpory, preverit vztah medzi DISH a antigenom HLA-B27 v slovenskej populacii v novej zostave chorych. Studovany subor tvorilo 81 nepribuznych pacientov s DISH, v ktorom sa sledovali antigeny HLA-A,B,C. Zistila sa statisticky vyznamne zvysena frekvencia antigenu HLA-B27 u chorych (33,3 %) oproti kontrolnej populacii (8,9 %; chi² = 41,04; Pcorr<0,01, relat. riziko - 5,1). Tieto vysledky su v zhode s vysledkami dvoch nasich predchadzajucich studii. Frekvencia HLA-B27 pri DISH (32,5 %; 32,0 %; 33,3 %) aj hodnota relativneho rizika (4,9; 4,8; 5,1) je vo vsetkych 3 pracach priblizne rovnaka, co dokazuje, ze uvedena asociacia nebude v slovenskej populacii nahodnym nalezom. Teda antigen HLA-B27 je v slovenskej populacii asociovany, okrem skupiny seronegativnych spondartritid, aj s DISH. Tento fakt treba mat na zreteli predovsetkym pri vyuziti typizacie HLA-B27 v klinickej praxi. Imunogeneticka analyza je doplnena o rodinne studie. Vysetrilo sa 9 rodin probandov s DISH, spolu 50 osob. Rodinne studie nevylucuju moznost, ze predpokladany gen pre DISH je lokalizovany na 6. chromozome v blizkosti HLA-oblasti - geneticka vazba (hodnotila sa metodu LOD-skore). Asociacia medzi DISH a HLA-B27 by sa mohla potom pozorovat ako dosledok vazbovej nerovnovahy. Teda vztah s HLA-B27 moze mat inu podstatu pri DISH ako pri seronegativnych spondartritidach, kde sa v sucasnosti preferuje priama ucast antigenu B27 v patogeneze ochorenia.
Klucove slova: difuzna idiopaticka skeletalna hyperostoza, imunogeneticke aspekty, antigen HLA-B27, vazbova nerovnovaha.

Summary
The association between diffuse idiopathic skeletal hyperostosis (DISH) and HLA-B27 antigen continues to be the subject of discussion, since it was found only in 4 studies, among them also in the Slovak population. The aim of the presented study is, with regard to the persisting discrepancies, to verify the relation between DISH and HLA-B27 in the Slovak population in a new group of patients. The studied group was formed by 81 non-related DISH patients, in which HLA-A,B,C antigens were studied. A statistically significant frequency of HLA-B27 in patients (33.3 %) was found against the control population (8.9 %; chi² = 41.04; Pcorr<0.01, relat. risk - 5.1). These results correspond to the results of our two previous studies. The HLA-B27 frequency in DISH (32.5 %; 32.0 %; 33.3 %) as well as the relative risk value (4.9, 4.8, 5.1) in all the 3 studies is approximately the same, demonstrating that the mentioned association in the Slovak population is not a random finding. The HLA-B27 antigen in Slovak population is, thus, associated, except for the group of seronegative spondarthritides, also with DISH. This fact has to be born in mind, especially in relation to the use of HLA-B27 typing in the clinical practice. The immunogenetic analysis is completed by the familial studies. Nine families of probands with DISH were examined, the total of 50 persons. The familial studies do not exclude the possibility that the presupposed gene for DISH is localized on the 6th chromosome in the vicinity of the HLA-region - genetic linkage (evaluated by the LOD scores method). The association between DISH and HLA-B27 could be observed than as a consequence of the linkage disequilibrium. Thus, the relation to HLA-B27 in DISH can be of a different nature than in the seronegative spondarthritides, where in the present time, it is preferred that the B27 antigen plays a direct role in the pathogenesis of the disease.
Key words: diffuse idiopathic skeletal hyperostosis, immunogenetic aspects, antigen HLA-B27, linkage disequilibrium.

pp. 69 - 72

DIAGNOSTIKA A PROGNOZA ZMIESANEHO SYNDROMU SPOJIVA (MCTD)

THE DIAGNOSTICS AND PROGNOSIS OF MIXED CONNECTIVE TISSUE DISEASE (MCTD)

J. LUKAC, J. ROVENSKY, L. CEBECAUER, D. ZITNAN

Vyskumny ustav reumatickych chorob, Piestany,
Riaditel: prof. MUDr. J. Rovensky, DrSc.

Suhrn
Zmiesana choroba spojiva (mixed connective tissue disease - MCTD) sa poklada za syndrom v ramci difuznych chorob spojiva (DCHS), problematika jej diagnostiky a prognozy vsak nie je zatial uspokojivo doriesena.
Cielom prace bolo na zaklade klinickych a imunologickych znakov MCTD a inych DCHS posudit kriteria pre urcenie diagnozy MCTD a na zaklade dlhodobeho sledovania pacientov s touto diagnozou vyhodnotit prognozu MCTD.
V subore 34 pacientov (32 zien a 2 muzov) sa urcila diagnoza MCTD, pricom u vsetkych pacientov sa vyskytoval Raynaudov fenomen (Rf), opuchnute (parkovite) prsty ruk alebo sklerodaktylia, protilatky anti-U[1]RNP v titroch vyssich ako 1:100 a pozitivita antinuklearnych protilatok s fluorescenciou zrniteho alebo hrudkoviteho typu - pri negativite anti-Sm, anti-dsDNA, anti-DNP a LE-testu. Nik zo suboru nesplnal kriteria pre systemovy lupus erythematosus (SLE), reumatoidnu artritidu (RA), systemovu sklerozu (SS) - sklerodermiu alebo ich prekryte syndromy. V casovom intervale 3 az l4 rokov sa u 6 z nich rozvinul typicky obraz SLE, z toho v 5 pripadoch s lupus-nefritidou - u troch i s nefrotickym syndromom a u vacsiny pacientov i s pozitivitou anti-dsDNA a anti-DNP. Titre anti-U[1]RNP sa znizili pod 1:50 (u 2 pacientov) alebo vymizli (4 pacienti). U dvoch pacientov sa zaznamenal vyvoj prekryteho syndromu SLE/SS. U 2 chorych sa rozvinul obraz SS a u jedneho pacienta prekryty syndrom RA/SS. Z retrospektivnej analyzy suboru sa nepodarilo zistit klinicke, ani imunologicke znaky, na zaklade ktorych by bolo mozne takyto vyvoj predvidat.
Z vysledkov vyplyva, ze MCTD je syndromom v ramci DCHS a jeho klinicky obraz je kombinaciou klinickych znakov viacerych z nich (SLE, SS, polymyozitida). Hoci ho mozno relativne dobre definovat, patognomicke znaky pre MCTD nejestvuju. Pri urceni diagnozy MCTD je potrebne vylucit DCHS, do ktorych sa MCTD moze rozvinut.
Klucove slova: zmiesany syndrom spojiva, MCTD - diagnostika a prognoza, anti-U[1]RNP, prekryty syndrom.

Summary
Mixed connective tissue disease (MCTD) is considered a syndrome belonging to the diffuse connective tissue diseases, (DCTD) but the problems of its diagnostics and prognosis have not yet been satisfactorily solved.
The aim of the study was to evaluate criteria for establishing the MCTD diagnosis on the basis of the clinical and immunological signs of MCTD and other diffuse connective tissue syndrome and to evaluate the prognosis of MCTD on the basis of a long-term study of the patients with this diagnosis.
In the group of 34 patients (32 women, 2 men), diagnosis of MCTD was established - all patients had presence of Raynaud's phenomenon (Rf), swollen (sausageous digits of hands or sclerodactyly, anti-U[1]RNP antibodies in titers higher than 1:100 and positivity of antinuclear antibodies with fluorescence of the speckled type - with negativity of anti-Sm, anti-dsDNA, anti-DNP and LE test. No person did fulfil criteria for systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SS) or their overlap syndromes. In the time-interval 3 to 14 years, in 6 persons a typical SLE pattern developed, of whom in 5 cases with lupus-nephritis - in three also with nephrotic syndrome, and in most patients also with anti-dsDNA and anti-DNP positivity. Titers of anti-U[1]RNP decreased under 1:50 (in 2 patients) or disappeared (4 patients). In two patients overlap syndrome SLE/SS developed. In 2 patients the pattern of SS and in one patient overlap syndrome RA/SS developed. The retrospective analysis of the group did not reveal clinical nor immunological signs on the basis of which these developments could have been foreseen.
The results demonstrate that MCTD is a syndrome belonging to DCTD and its classical pattern is a combination of clinical signs of several of them (SLE, SS, polymyositis). Although MCTD can be relatively well defined, pathognomic signs for MCTD do not exist. In the process of MCTD diagnostics, it is necessary to exclude the DCTD into which MCTD can develop.
Key words: mixed connective tissue disease, MCTD - diagnostics and prognosis, anti-U[1]RNP, overlap syndrome.

pp. 73 - 80

PROTILATKY PROTI HISTONOM PRI SYSTEMOVYCH CHOROBACH SPOJIVA II. ELISA S IZOLOVANYMI HISTONOVYMI FRAKCIAMI

ANTI-HISTONE ANTIBODIES IN SYSTEMIC CONNECTIVE TISSUE DISEASES II. ELISA WITH ISOLATED HISTONE FRACTIONS

L. CEBECAUER, J. LUKAC, M. CEBECAUER¹, J. ROVENSKY

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
¹Oddeleni klinicke imunologie 1. lekarske fakulty University Karlovy, Praha
Prednosta: doc. MUDr. T. Fucikova, DrSc.

Suhrn
V druhej casti serie o protilatkach proti histonom - AHA sa venuje pozornost analyze metodou ELISA s izolovanymi histonovymi frakciami H1, H2A/H2B a H3/H4, ktore sa urcili popri anti-DNA v subore 99 chorych so systemovymi chorobami spojiva (83 SLE a 16 ine - nonSLE) s pozitivitou anti-DNP ELISA. Podobne ako imunoblotom aj metodou ELISA sa urcili najcastejsie AHA namierene proti histonu H1 a H2A/H2B, hoci sa lisia konformaciou, ked pouzity izolacny postup umoznil ziskat dimery v nativnej konformacii. Pozitivita anti-DNP a negativita anti-DNA a AHA v niektorych serach naznacuje, ze v takychto serach su protilatky reagujuce s chromatinom - teda vyhradne s DNP. Taketo protilatky su castejsie v serach chorych so systemovymi reumatickymi chorobami inymi ako SLE.
Klucove slova: autoprotilatky, SLE, systemove choroby spojiva, protilatky proti histonom, protilatky proti DNA, protilatky proti DNP.

Summary
In the second part of the serie about antihistone antibodies - AHA is the attention oriented to the analysis of AHA using the ELISA method with isolated histones H1, H2A/H2B and H3/H4. AHA were estimated besides anti-DNA in the group of 99 patients with systemic connective tissue diseases (83 SLE and 16 others - nonSLE) all positive in anti-DNP ELISA. Similarly as in the immunoblotting, also in the assay by ELISA predominated as most frequent AHA against histones H1 and H2A/H2B, though their conformation was different, as the isolation procedure used allowed for obtainning the histone dimers in their native conformation. Positivity of anti-DNP and negativity in anti-DNA assays in some of the investigated sera indicates that in those sera antibodies reactive exclusively with chromatin were found; these are true anti-DNP. Such a type of antibodies was more frequent in the sera of patients with systemic rheumatic diseases other than SLE.
Key words: autoantibodies, SLE, connective tissue diseases, anti-histone antibodies, anti-DNA antibodies, anti-chromatin antibodies, anti-DNP.

pp. 81 - 84

PILOTNA STUDIA KOSTNEJ DENZITY U ZDRAVYCH STARSICH OSOB

A PILOT STUDY OF BONE DENSITY IN HEALTHY OLDER PERSONS

P. MASARYK, A. LETKOVSKA, K. BITTER

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof.MUDr. J. Rovensky, DrSc.

Suhrn
Kostna denzita je jeden z faktorov, ktore by sa mohli zucastnovat na rozdielnej prevalencii osteoporotickych fraktur v jednotlivych populaciach.
Cielom pilotnej studie bolo zistit hodnoty kostnej denzity v populacii Slovenska u starsich zdravych osob nad 50 rokov a porovnat ich s referencnou europskou populaciou.
Autori vysetrili v ramci studie EVOS (Europska studia vertebralnej osteoporozy) 637 osob vo veku nad 50 rokov ziskanych nahodnym vyberom a z tohto suboru vyclenili osoby, ktore povazovali za zdrave z hladiska poruch kostneho metabolizmu. Celkovo vysetrili 48 osob, z toho 24 zien a 24 muzov, priblizne rovnomerne rozdelenych po jednotlivych dekadach. U tychto osob sa merala plosna denzita (BMD) lumbalnych stavcov L2-L4 a krcka stehnovej kosti na denzitometri NORLAND XR-26 a hodnoty boli vyjadrene vo forme Z-skore oproti referencnym hodnotam ulozenym v programovom vybaveni denzitometra.
Hodnoty BMD lumbalnych stavcov aj krcka femuru boli u muzov vyssie ako u zien. Pri porovnani s referencnou europskou populaciou mali hodnoty Z-skore lahko zvysene hodnoty u oboch pohlavi a v oboch meranych lokalizaciach: chrbtica muzi Z=0,37 n.s., zeny Z=0,48 n.s., krcek muzi Z=0,003 n.s., zeny Z = 0,46 (p<0,01).
Lahko zvysena kostna denzita u starsich osob obyvatelov Slovenska by mohla ciastocne vysvetlovat nizsiu prevalenciu osteoporotickych zlomenin v porovnani s niektorymi europskymi krajinami. Vysledky su zatial len predbezne a v praci sa bude pokracovat v II. etape Europskej studie vertebralnej osteoporozy.
Klucove slova: kostna denzita, zdrava starsia populacia, pilotna studia.

Summary
Bone density is one of the factors which could play a role in different prevalence of osteoporotic fractures in the individual populations.
The aim of the pilot study was to find out the values of bone density in Slovak population, in healthy older persons over 50 and to compare them with reference data of the European population.
In the EVOS (European vertebral osteoporosis study), the authors examined 637 persons aged more than 50 years included by random choice and of this group they chose persons healthy from the point of view of bone metabolism disorders. They examined the total of 48 persons, of which 24 women and 24 men, almost equally distributed in the individual decades. In these persons bone mineral density (BMD) of lumbar vertebrae L2-L4 and femoral neck was measured on densitometer NORLAND XR-26 and the values were expressed under the form of Z-scores against the reference values, stored in the densitometer software.
The BMD of the lumbar vertebrae as well as the femoral neck were higher in men than in women. In comparison with the reference data of the European population the Z-scores manifested slightly increased values in both sexes and in both measured localisations: spine men Z=0.37 n.s., women Z=0.48 n.s., femoral neck men Z=0.003 n.s., women Z=0.46 (p<0.01).
The slightly increased bone density in older persons in Slovakia could partly explain a lower prevalence of osteoporotic fractures in comparison with some European countries. The results are so far preliminary and the study will continue in the second phase of the European study of vertebral osteoporosis.
Key words: bone mineral density, healthy older population, pilot study.

pp. 85 - 88

VPLYV KOMPLEXOV MEDI NA ADJUVANTNU ARTRITIDU POTKANOV

THE INFLUENCE OF COPPER COMPLEXES ON RAT ADJUVANT ARTHRITIS

K. SVIK, M. STANCIKOVA, J. ROVENSKY, M. MELNIK¹

Vyskumny ustav reumatickych chorob, Piestany
Riaditel: prof. MUDr. J. Rovensky, DrSc.
¹Katedra anorganickej chemie, CHTF STU, Bratislava
Veduci: prof. RNDr. M. Melnik, DrSc.

Suhrn
Vyuzitie mednatych komplexov v ulohe zhasacov alebo putacov reaktivnych stavov kyslika, ako su superoxidovy anion a hydroxylovy radikal, je stale aktualne. Navyse sa od tychto zlucenin ocakava, ze pri liecbe artritidy by mohli nahradit toxickejsie zluceniny zlata.
Cielom nasho pokusu bolo sledovanie vplyvu niflumatu mednateho [Cu(nif)[2]] a ronikoloveho aduktu tejto zluceniny [Cu(nif)[2](ron)[2]] na model adjuvantnej artritidy potkanov.
Samcom inbrednych potkanov kmena Lewis zivej hmotnosti 220-240 g bola indukovana adjuvantna artritida intradermalne tepelne usmrtenymi Mycobacterium butyricum v inkompletnom Freundovom adjuvanse. Artriticke potkany boli potom liecene komplexmi medi: Cu(nif)[2] a Cu(nif)[2](ron)[2] v dvoch davkach (60 mg a 80 mg/kg zivej hmotnosti/den), per os kazdych 48 hodin. Zo zapalovych a artritickych ukazovatelov sme urcovali: serovy albumin a hyaluronan, sledovali sme aj opuchy, rtg zadnych koncatin i zivu hmotnost potkanov.
Signifikantne zmeny sme pozorovali u potkanov liecenych davkou 80 mg Cu(nif)[2](ron)[2]. Vyznamne sa znizila serova koncentracia hyaluronanu v krvnom sere, opuchy a rozsah kostnych erozii klbov zadnych koncatin (podla rtg). Aj davky Cu(nif)[2] a Cu(nif)[2](ron)[2] v mnozstve 60 mg/kg znizovali sledovane ukazovatele, vyznamne rozdiely medzi liecenymi a neliecenymi zvieratami sme vsak zistili len v pripade opuchov zadnych koncatin.
Mednaty komplex Cu(nif)[2](ron)[2] v davke 80 mg/kg zivej hmotnosti sa javi ako ucinna latka tlmiaca vyvoj artritidy u potkanov s indukovanou adjuvantnou artritidou.
Klucove slova: mednate komplexy, protizapalove latky, model adjuvantnej artritidy.

Summary
The use of copper complexes in the role of scavengers or „lures" of reactive oxygen species, such as superoxide anion and hydroxyl radical continues to be studied. Moreover, these compounds are expected to replace in the arthritis treatment the more toxic gold compounds.
The aim of our experiment was to study bis-(niflumate)copper (II) [Cu(nif)[2]] and ronicol adduct (3-pyridilcarbinole adduct) of this compound [Cu(nif)[2](ron)[2]] on the model of adjuvant arthritis of rats.
In the male inbred rats of Lewis strain of the body-weight 220-240 g, adjuvant arthritis was induced intradermally by heat-killed Mycobacterium butyricum in incomplete Freund's adjuvant. The arthritis rats were then treated by copper complexes: Cu(nif)[2] and Cu(nif)[2](ron)[2] in two dosages (60 mg and 80 mg/kg body-weight/day) per os every 48 hours. Of the inflammation and arthritis markers serum albumin and hyaluronan were assessed, as well as swelling, X-rays of the hind paws and the body-weight of the rats.
Significant changes were observed in the rats treated by 80 mg/kg dose of Cu(nif)[2](ron)[2]. There was a significant decrease of serum hyaluronan concentration, of the swelling and the extent of the bone erosions of the hind paw joints (on X-rays). The 60 mg/kg doses of Cu(nif)[2](ron)[2] decreased also the studied markers, but significant differences between the treated and untreated animals were found only in the hind-paws swelling.
The copper complex Cu(nif)[2](ron)[2] in the dosage 80 mg/kg body-weight was demonstrated to be an affective drug inhibiting the development of arthritis in rats with adjuvant arthritis.
Key words: copper complexes, antiinflammatory drugs, rat adjuvant arthritis.

pp. 89 - 94

ANALYZA UCINKU Cu(nif)[2](ron)[2] NA OBLICKY NZB/W F[1] MYSI IMUNOHISTOCHEMIA

ANALYSIS OF THE Cu(nif)[2](ron)[2] EFFECT ON KIDNEYS OF NZB/W F[1] MICE IMMUNOHISTOCHEMISTRY

J. LISKA¹, L. DANIHEL³, J. PORUBSKY³, D. ZELIENKOVA²

¹Ustav experimentalnej farmakologie Slovenskej akademie vied, Bratislava
Riaditel: doc. MUDr. V. Bauer, DrSc.
²Statny ustav pre kontrolu lieciv, Bratislava
Riaditel: doc. RNDr. L. Martinec, CSc.
³Ustav patologickej anatomie Lekarskej fakulty Univerzity Komenskeho, Bratislava
Prednosta: prof. MUDr. M. Zaviacic, DrSc.

Suhrn
Oblicky intaktnych NZB/W F[1] mysi a NZB/W F[1] mysi, ktore dostavali peroralne mednaty pripravok Cu(nif)[2](ron)[2], sme vysetrili pomocou protilatok proti glomerulovym bazalnym membranam (antiGBM), proti fibronektinu a pomocou protilatok proti mysim imunoglobulinom. Pocas starnutia mysi dochadzalo v mezangiu glomerul k pribudaniu fibronektinu. Aplikacia Cu(nif)[2](ron)[2] vyvolala v mezangiu 9-mesacnych mysi ubytok fibronektinu. AntiGBM ukazali prirastok mezangium matrix a hrubnutie GBM u 9-mesacnych neliecenych mysi. S pribudajucim vekom mysi sa najma v mezangiu zvysovala depozicia imunoglobulinov. Mednaty pripravok tymto zmenam zabranoval. Vo vyssich davkovych skupinach bol obraz roznorody, prekryty jazvovymi zmenami v kore obliciek.
Klucove slova: imunohistochemia, NZB/W F[1] mysi, oblicky, morfologia, med, terapia, fibronektin, imunoglobulin, glomerulove bazalne membrany.

Summary
The kidneys of the intact NZB/W F[1] mice and the NZB/W F[1] mice which received peroral copper preparation Cu(nif)[2](ron)[2] were examined by means of antibodies against the glomerular basement membranes (antiGBM), against fibronectin and by means of antibodies against the mice immunoglobulins. In course of the ageing of mice, in the glomerular mesangium fibronectin increased. The Cu(nif)[2](ron)[2] application in the mesangium of the 9-month old mice induced a decrease of fibronectin. The antiGBM showed the matrix mesangium increase and GBM thickening in the untreated 9-month old mice. With the increasing age of mice, depositions of immunoglobulins increased especially in the mesangium. These changes were prevented by the copper preparation. In the higher dosage groups, the pattern varied, being overlapped by scarred changes in the kidney cortex.
Key words: immunohistochemistry, NZB/W F[1] mice, kidneys, morphology, copper, therapy, fibronectin, immunoglobulin, glomerular basement membranes.

pp. 95 - 103

PRVNI NAHRADA RAMENNIHO KLOUBU CESKE PROVENIENCE - PREDBEZNE VYSLEDKY KLINICKEHO SLEDOVANI

THE FIRST SHOULDER-JOINT ENDOPROSTHESIS OF THE CZECH PROVENIENCE - PRELIMINARY RESULTS OF A CLINICAL STUDY

M. SEDLACKOVA¹, K. PAVELKA¹, A. SOSNA², V. FRIC²

¹Revmatologicky ustav, Praha
Reditel: doc. MUDr. K. Pavelka, CSc.
²I. ortopedicka klinika VFN LFUK, Praha
Prednosta: prof. MUDr. A. Sosna, DrSc.

Souhrn
V praci je podan prehled vysledku implantaci nahrady ramenniho kloubu (vyrobce Pro-Spon, Ceska republika) u pacientu s revmatoidni artritidou (RA) a u pacientu po urazu ramene, ktere byly provedeny na I. ortopedicke klinice VFN LFUK v Praze v letech 1991-1993. Operovano bylo celkem 22 pacientu, z toho 5 s RA a 17 pourazovych stavu. Vyhodnoceno bylo celkem 16 nemocnych. Hlavnim pozitivem operacniho zasahu bylo snizeni bolesti a zlepseni kvality zivota nemocnych (hodnoceno pomoci dotazniku podle Constanta a HAQ). Zlepseni aktivni a pasivni hybnosti bylo prukazne, ale jen mirne. Presto ve skupine nemocnych s RA udavali spokojenost s operaci 4 z 5 nemocnych, ve skupine pourazove 10 z 11 nemocnych. Byl vypracovan postup rehabilitace po operaci rozdeleny do tri fazi. Nase zavery povazujeme za predbezne, protoze je nutne skupinu rozsirit, vyhodnotit v delsim casovem odstupu a zamerit se i na zmeny v rtg obraze. Presto lze nahradu Pro-Spon hodnotit jako perspektivni. Jejim dalsim nemalym prinosem je jeji nizka cena ve srovnani s dalsimi srovnatelnymi implantaty.
Klicova slova: ramenni kloub, totalni nahrada, cervikokapitalni nahrada.

Summary
The study presents results of shoulder-joint endoprosthesis implantations (producer Pro-Spon, Czech republic) to rheumatoid arthritis (RA) patients and patients after trauma of the shoulder, performed at the Ist Clinic of Orthopaedics of the VFN LFUK in Prague, in 1991-1993. The total of 22 patients underwent the surery, of which 5 with RA and 17 posttraumatic conditions. Sixteen of them were evaluated. The main benefit of the surgical intervention was the decrease of pain and improvement of the quality of life of patients (evaluated by the questionnaires according to Constant and HAQ). The improvement of the active and passive mobility, although only slight, was significant. Four of the 5 RA patients and 10 of 11 posttraumatic patients were satisfied with the outcome of the surgery. The rehabilitation method consisting of three phases, was elaborated. We consider our conclusions preliminary, since the group has to be enlarged and followed up after a longer time-interval and also examination of the X-ray changes has to be included. The Pro-Spon endoprosthesis can, nevertheless, be evaluated as perspective. Its further advantage lies in its low price in comparison with other comparable implants.
Key words: shoulder-joint, total endoprosthesis, cervico-capital prosthesis.

pp. 105 - 110

FIBRONEKTINY V ZDRAVI A CHOROBE

FIBRONECTINS IN HEALTH AND DISEASE

J. JAKUBOVSKY, J. PAPINCAK, S. HOLESA

Ustav patologickej anatomie Lekarskej fakulty Univerzity Komenskeho a Fakultnej nemocnice, Bratislava
Prednosta: prof. MUDr. M. Zaviacic, DrSc.

Suhrn
Fibronektiny su strukturne a antigenovo pribuzne glykoproteiny s funkciou molekuloveho tmelu. V dostatocnej miere je preskumany problem ich stavby, zlozenia, studuju sa ich vztahy k integrinom. Dostatocne su vedomosti o ich funkcii za normalnych, menej za patologickych okolnosti. Cielom prehladu je informacia o sucasnom stave poznania fibronektinov a naznacenie moznosti ich uplatnenia v chorobnych procesoch. Zucastnuju sa na vzajomnych interakciach, adhezii a migracii buniek, na organizacii cytoskeletu, v embryonalnom vyvoji a morfogeneze, v hemostaze, hojeni ran. Povrchovy fibronektin stracaju transformovane a neoplasticke bunky. Ukazuju sa moznosti uplatnenia analyzy fibronektinov v analyzach spojiva poskodeneho chorobnym procesom. Funkcna morfologia ucasti fibronektinov (ilustrovane z vlastneho materialu) na interpretacii ortomorfologickych a patomorfologickych nalezov ma pred sebou otvorene znacne neprebadane pole.
Klucove slova: fibronektin, struktura, lokalizacia, kratky referat.

Summary
Fibronectins are structurally and antigen related glycoproteins with the function of molecular glue. Their structure and composition have been thoroughly investigated, their relations to integrins is studied. Their function under normal circumstances is well-known, less known is their function under pathologic circumstances. The aim of the review is the information on the present state of the knowledge of fibronectins and an indication of their possible roles in the pathologic processes. They are involved in the mutual interactions, adhesion and migration of the cells, in the cytoskeleton organization, in the embryonal development and morphogenesis, in haemostasis and healing of wounds. The transformed and neoplastic cells are losing the surface fibronectin. Possibilities of the utilization of fibronectin analysis in the analyses of pathologically damaged connective tissue are opened up. The functional morphology of the role of fibronectins in the interpretation of orthomorphologic and pathomorphologic findings is still largely an unexplored ground.
Key words: fibronectin, structure, localization, short review.

pp. 111 - 118

SYSTEMOVE PRIMARNE IDIOPATICKE VASKULITIDY (VELKYCH A STREDNYCH CIEV)

SYSTEMIC PRIMARY IDIOPATHIC VASCULITIDES (INVOLVING LARGE AND MEDIUM-SIZED VESSELS)

V. STVRTINOVA

II. interna klinika LFUK, Bratislava
Prednosta: prof. MUDr. I. Balazovjech, DrSc.

Suhrn
Pod pojem vaskulitidy zahrnujeme skupinu heterogennych ochoreni, casto neznamej etiologie, ktore su charakterizovane zapalom a nekrozou cievnej steny. Nasledok takehoto cievneho zapalu zavisi od velkosti, miesta a poctu postihnutych krvnych ciev. Zapal cievy moze vzniknut de novo ako esencialna porucha krvnych ciev (primarne vaskulitidy) alebo v ramci nejakeho ineho zakladneho ochorenia (sekundarne vaskulitidy). V konecnom dosledku vedie zapal cievnej steny k ischemii a nekroze tkaniv, ktore su vyzivovane postihnutymi cievami.
Medzi primarne systemove vaskulitidy s najtazsim priebehom patri polyartheritis nodosa, thromboangiitis obliterans, Wegenerova granulomatoza, Churgov-Straussov syndrom, Hortonova obrovskobunkova arteritida a Takayasuova arteritida. V praci sa analyzuje etiopatogeneza, klinicky obraz, moznosti diagnostiky a liecby uvedenych ochoreni. Ide o ochorenia, ktore sa sice vyskytuju velmi zriedkavo, ale v ramci diferencialnej diagnostiky sa s nimi moze stretnut kazdy internista.
Klucove slova: polyartheritis nodosa, Churgov-Straussov syndrom, Wegenerova granulomatoza, thromboangiitis obliterans, Takayasuova arteritida, temporalna arteritida.

Summary
Vasculitides are a heterogenous group of diseases with unknown ethiology which are characterized by the inflammation and necrosis of blood vessels leading eventually to ischemia and necrosis of tissues perfused by the affected vessels. The consequence of such a vessel inflammation depends on the size, localization and number of affected blood vessels. Vasculitides can be devided into two groups: primary vasculitides (developed as an essential disorder of the blood vessels) and secondary vasculitides (associated with a variety of different underlying diseases).
The most serious primary systemic vasculitides include polyartheritis nodosa, thromboangiitis obliterans, Wegener's granulomatosis, Churg-Strauss syndrome, granulomatous (giant cell) temporal arteritis and Takayasu's arteritis. In this review, the ethiopathogenesis, clinical features, diagnostic and therapeutic possibilities of these diseases are discussed. Though they are rare, each physician can meet them in his everyday practise.
Key words: polyartheritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, thromboangiitis obliterans, Takayasu's artheritis, giant cell temporal artheritis.

pp. 119 - 128