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Pol Merkur Lekarski [journal]
- [Glycoxidative modification of albumin in medical research]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):239-42.
Human albumin is a major, multi-functional serum protein. As the other protein is subjected to many modifications, including glycation and oxidation, which occurs physiologically in low intensity, however, are significantly increased in various pathological conditions. They often co-occur with each other, reinforcing its negative effects, and therefore are referred to common name - glycoxidative processes. Glycation, increased especially in diabetes, causes structural and functional changes of many proteins, both short-and long-lived, and it may result in increased oxidative stress and protein oxidation, which secondarily may increase their susceptibility to glycation. Studies in vivo and in vitro processes of oxidation and glycation of albumin and other proteins allowed us to identify biochemical markers that are routinely used in the diagnosis and monitoring of diseases (ischemia modified albumin, fructosamine) and those commonly used in research (e.g. AGE, CML, SH and CO groups, AOPP), which in perspective could be used in clinical trials (especially AGEs and AOPP). The study presents current state of knowledge on the mechanisms, the importance and the possibility of using glycoxidative modified albumin in medical science.
- [FGF-23 and Klotho protein - new markers in chronic kidney disease?]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):235-8.
Disorders of calcium and phosphate metabolism are among the major problems in patients with chronic kidney disease (CKD), especially undergoing chronic dialysis. Besides the classic parathyroid-kidney axis, in recent years the existence of an endocrinological bone-kidney axis has been established, which allows better explanation of calcium and phosphate metabolism pathophysiology and secondary hyperparathyroidism in CKD. Fibroblast growth factor 23 (FGF-23) and its co-factor alpha-Klotho protein are the most important factors in the axis. The role of FGF-23 and Klotho protein, their mechanisms of action and significance in CKD have been presented. In ealy stages of CKD the increase of FGF-23 level precedes the decline in vitamin 1.25 (OH)2D3 and the increase of PTH level. Some studies showed correlation between the elevated FGF-23 level and increased mortality from cardiovascular disease in patients with chronic kidney disease. Clinical usefulness of determinations of FGF-23 and Klotho protein in chronic kidney disease is currently investigated.
- [The usefulness of natriuretic peptides measurements in the diagnostics of chosen cardiovascular diseases]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):232-4.
Natriuretic peptides compose the group of neurohormones produced by the myocardium in response to its walls stretching caused by the volume or pressure overload. They restrain the sodium kidney reabsorbtion, thus increasing the diuresis and natriuresis. They also participate in blood pressure, initial load as well as the water-mineral balance regulation. The main representatives of this group are ANP (atrial natriuretic peptide) and BNP (brain netriuretic peptide). With regard to slow dynamics of the serum levels changes, the measurements of BNP play an important role in cardiological diagnotics. Its serum concentration raises in these cardiovascular diseases that are connected with the left ventricle overload. So it can be treated as a specific left ventricle dysfunction marker, whereas its high concentrations correlate with the functional class according to NYHA. It also can be used in risk stratification in patients with the acute coronary syndrome and pulmonary embolism, as well as helping to differentiate the pulmonary and cardiac causes of acute dyspnoea. The serum level of NT-proBNP (N-terminal propeptide of brain natriuretic peptide) is also the independent predictive factor of the recurrence of atrial fibrillation after the restoring the sinus rhythm.
- [Chronic inflammation and metabolic syndrome in comparison with other signs belonging to the image of polycystic ovary syndrome]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):228-31.
Polycystic ovary syndrome (PCOS) is a disorder which concern even 5-10% of women in reproductive age. PCOS is a cause of hyperandrogenism and menstrual disorders with chronic anovulation. The most common clinical symptoms observed in PCOS are hirsutism, acne and obesity. Patients with PCOS often suffer from metabolic disorders like insulin resistance, hyperinsulinemia, dyslipidemia, arteriosclerosis and other abnormalities of the metabolic syndrome. 35 to 60% of women with PCOS are obese and about 50% of them have insulin resistance and hyperinsulinemia. The pathogenesis of atherosclerosis emphasizes the role of inflammatory processes. There are a number of markers of the inflammation process. They are also observed in PCOS and may indicate an increased risk of cardiovascular disease in women. More than 46% of women with PCOS can be diagnosed with metabolic syndrome. Because of the fact that patients with PCOS are at higher risk group of the earlier development of complications such as diabetes t 2, atherosclerosis, hypertension and cardiovascular system diseases, it is important to carry out metabolic disorders diagnosis in every patient with PCOS. It will help to estimate the risk of complications and allow for the implementation of prevention or treatment of metabolic diseases belonging to the image of PCOS.
- [Influence of suitable home care on convalescence of the patient in heavy general condition - case report]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):224-7.
The case of 78 year-old patient with diseases of cardio-vascular system and cancer of prostate gland in anamnesis has been described below. The reason for surgery and pharmacological treatment was a hemorrhagic shock in the course of aneurysm rupture of the left common iliac artery. The following complications appeared while saving his life: heavy failure of cardio-respiratory system, kidneys failure, generalized infection, tracheoesophageal fistula, bedsores of the body and in the nose, pareses and the rigor of auriculars. After stabilizing his general condition, the patient with efficient respiratory and circulatory system was released home. The aim of this work is to prove a positive influence of suitable care on his convalescence.
- [Reversible dilated cardiomyopathy as an atypical form of takotsubo cardiomyopathy]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):219-23.
Stress-induced cardiomyopathy is characterized by transient regional left ventricular (LV) dysfunction that may involve, in different forms, midventricular, apical or basal segments. The authors describe a case of a 41-year-old woman with reversible, but global LV systolic dysfunction, complicated with apical thrombi. Clinical symptoms of dilated cardiomyopathy were preceded by persistent stressful workplace conditions. Ischemic, inflammatory, metabolic and endocrine causes of the disease were excluded. After 6 weeks, complete recovery of LV function in echocardiography and normal cardiac magnetic resonance imaging were observed, despite only modest doses of ramipril, carvedilol and diuretics. Six months later, as a result of another episode of emotional stress, she was hospitalized for typical takotsubo cardiomyopathy. Reversible global LV hypokinesis may be an atypical variant of stress-induced cardiomyopathy.
- [Surgical treatment of malignant eyelid tumors]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):214-8.
Eyelid tumors constitute 5 to 10% of all skin malignancies. They mostly affect the elderly, chronically exposed to sunlight. The primary treatment is radical surgical excision of the tumor. The aim of this study was the clinical and microscopical analysis of malignant eyelid tumors in treated patients, the presentation of selected reconstructive methods and the evaluation of long-term results of surgical treatment of eyelid tumors.The study involved 92 patients treated in 2000-2007 for malignant tumors of the eyelids. All patients underwent surgical excision of the tumor with concurrent eyelid reconstruction. The choice of reconstructive method depended on the size and location of the tumor. Histopathological evaluation was carried out specifying the type of cancer and radical surgery. The long-term results were rated on the basis of medical records and patients' examinations.Tumors were located mostly within the lower eyelid 67 (70.5%) and the medial canthus 17 (17.9%). Basal cell carcinoma was found in 83 (87.3%) cases, while in 12 (12.7%) diagnosed with other, less common cancers. Histopathological verification of tumor margins revealed incomplete excision in 14 specimens (14.7%). Reoperations due to recurrent tumor was performed in 11 (15.6%) cases. Good long-term results of functionally-aesthetic reconstruction of the eyelids was observed in 84 (91.3%) patients.1. Basal cell carcinoma is the most common malignant tumor of the oculopalpebral region and originate mainly in the lower eyelid. 2. Significantly higher risk of recurrence exists in a more aggressive form of BCC (infiltrative basal-cell carcinoma) and tumors located in medial canthus. 3. The knowledge of multiple reconstruction methods allows the surgeon to choose the most appropriate one, depending on the size and location of the defect formed after excision of the tumor.
- [Refractive errors in patients with cerebral palsy]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):210-3.
Ocular changes are common in patients with cerebral palsy (CP) and they exist in about 50% of cases. The most common are refractive errors and strabismus disease. The aim of the paper was to estimate the relativeness between refractive errors and neurological pathologies in patients with selected types of CP. MATERIAL AND METHODS. The subject of the analysis was showing refractive errors in patients within two groups of CP: diplegia spastica and tetraparesis, with nervous system pathologies taken into account. Results. This study was proven some correlations between refractive errors and type of CP and severity of the CP classified in GMFCS scale.Refractive errors were more common in patients with tetraparesis than with diplegia spastica. In the group with diplegia spastica more common were myopia and astigmatism, however in tetraparesis - hyperopia.
- [Evaluation of the arterial blood flow parameters in the eye of myopic patients]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):205-9.
Myopia is a common refractive defect. Has a good vision from near and deterioration of vision with increasing distance. The main reason for its occurrence is too long axis of the eyeball. The consequence of elongation of the eyeball is the development of degenerative changes in the retina. Despite much research has failed to clearly identify the causes of degenerative changes in those short-sighted. The aim of the study was to evaluate the maximum and minimum speed in arterial blood vessels of the eye in people with myopia.The study included 70 patients (138 eyes), 53 women and 17 men, aged from 18 to 79 years, with myopia of -0.25 to -18.0 Dsph and length of the eyeball from 22.61 to 33.36 mm. Depending on the kind and the degree of the progress of degenerative changes, patients were divided in 4 groups: I - without degenerative changes on the fundus (n=32; K-23, M-9); II- with the short-sighted sickle (n=20; K-14, M-6); Ill - with the structure thinned down of the retina, accompanying the short-sighted sickle (n = 8; K-6, M-2); IV - with extensive choroidal-retina disappearances in the fundus (n = 10; K-7, M-3). In all individuals enrolled underwent Color Doppler ultrasound with apparatus SSA 770A Toshiba Aplio with linear probe frequency 12 MHz, judging maximum (Vmax) and minimum (Vmin) speed in the arteries of the eye: ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) located on the nasal and temporal side of the optic disc. The results were statistically analyzed.No statistically significant relationship between the nature of degenerative changes of the eye, and blood velocity in the OA. There was a increase in Vmax and Vmin blood in OA in Group IV, but these changes were not statistically significant. Statistically significant correlation was observed while in the CRA. With a decrease in Vmax and Vmin of blood flowing through a vessel exacerbation of retinal degeneration. Vmax and Vmin changes in the blood did not correlate significantly SPCA with retinal degeneration, although the results were much worse in the temporal vessels.With the deterioration of blood flow parameters of the central retinal artery and short posterior ciliary arteries comes to the severity of the retinal degeneration in myopic patients. More severe impairment of blood circulation in the temporal ciliary explain higher incidence of degenerative changes in the temporal side of the optic disc.
- [Iodine supply and thyroid function in the group of healthy pregnant women living in Warsaw]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2013 Apr; 34(202):200-4.
Iodine deficiency and thyroid gland disorders are especially harmful for pregnant women and normal fetal development. After initiation in 1997 of obligatory iodine prophylaxis, Poland has been found since 2003 a country with sufficient delivery of this microelement. However, in the population of pregnant women, slight deficiency of this element still exists. Insufficient iodine supply results in abnormalities of thyroid hormones'biosynthesis. Simultaneously, adaptive changes, occurring in pregnancy, make the proper interpretation of hormone's assays difficult. Lack of normative data for the thyroid hormones concentration in the each pregnancy trimester for Polish population cause additional difficulties in the interpretation of these results. The aim of the study was prospective observation of iodine intake and thyroid function in healthy pregnant women supplemented with 150 pg of iodine daily62 healthy pregnant women living in Warsaw in the early weeks of pregnancy, confirmed by ultrasonographic examination, were included to this study. Pregnancies were singleton resulting in birth of healthy neonates. Urinary iodine concentrations (UIC), serum TSH, fT4, fT3, antyTPO, thyroid volume and morphology by the ultrasonography examination were assessed in consecutive trimesters of pregnancy. TSH level was measured in the each newborn.Low urinary iodine concentrations (UIC)-median 96 microg/l was found at the beginning of pregnancy Only in 14% of pregnant women UIC exceeded 150 microg/l. In spite of intended supplementation of at least 150 microg of extra iodine per day, medians of UIC in the next trimesters were 122 microg/l and 129 microg/l, respectively. TSH levels kept reference values for the 1st trimester of pregnancy in 86% of participants and in the next trimesters in 85% and 95%, respectively. Levels of fT4 were within reference range for the women in the 1st trimester. In 2nd trimester 12% and in 3rd trimester 33% of pregnant women had fT4 level below the reference value. Concentrations of fT3 were within reference values during whole pregnancy. Median thyroid volume was respectively 11.12 ml; 13.0 ml and 15.75 ml (range: 6.8-26.8 ml) in subsequent trimesters.Median neonatal' TSH level on the 3rd day of life, as a screening of thyroid insufficiency, was 1.34 mlU/l (range: 0.01-6.6 mlU/l) and in 4.41 % of newborns TSH concentrations were higher than 5 mlU/I.Despite the sufficient supply of iodine in the whole population, iodine consumption among the pregnant women is still not satisfactory. The increase of TSH values above the upper reference level for pregnant women in 15% of patients may be related to iodine deficiency. It is important to educate pregnancy planning women about this problem. Our observations confirm the importance of the recommendations that during the pregnancy every woman should receive supplementation of iodine at the minimal amount of 150 microg daily.