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In patients with primary aldosteronism (PA), it is fundamental to distinguish between subtypes that benefit from different treatment. The authors describe difficulties in differential diagnosis in a case of 46 year old women with PA and two strokes in the past. Based on high plasma and urine aldosterone concentration, low plasma renin activity (PRA), very high aldosterone/PRA ratio and unilateral macroadenoma detected in computed tomography, aldosterone producing adenoma was diagnosed and the patient was performed unilateral adrenalectomy. Despite the surgical treatment the patient still presented with clinical and biochemical PA symptoms. Moreover, histological examination suggested adrenal hyperplasia, and laboratory tests were typical for glucocorticoid-remediable aldosteronism. Unfortunately, we didn't find a chimeric CYP 11beta1/CYP 11beta2 gene. Finally, bilateral adrenal hyperplasia was diagnosed and medical treatment with aldosterone antagonist was initiated.

Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw., Material and Methods: The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment., Results: The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%., Conclusions: The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.

The authors describe a case of an adult woman with congenital adrenal hyperplasia caused by 11beta-hydroxylase deficiency. The patient presented not only typical features of this disease such as virilization and hypokaliemic hypertension but also rare pathologies, such as ectopic adrenal tissues, salt loss during infancy, and functional adrenomedullary hyperactivity. In spite of the severe disease and delays in its diagnosis and adequate treatment, significant improvement in appearance and normalization of blood pressure as well as the birth of a healthy child were achieved. The paper also discusses current opinions concerning the pathogenesis and treatment in CAH with 11beta-hydroxylase deficiency as well as difficulties in diagnostic and therapeutic management.

The Purpose: of this study was to look for effects of attachment styles for emotional reacting with depression in 117 lung cancer patients awaiting surgery and in 112 healthy subjects., Material and Methods: All subjects were classified according to their attachment style (secure, avoidant, ambivalent) assessed by means of the instrument based on Hazan and Shaver's (1987) descriptions of how people typically feel in close relationships. The Beck Depression Inventory was used to measure depression. Clinical group differed neither in age t(227)=0,32 p>0,7 (mean for controls 58,59; mean for clinicals 58,97) nor in sex chi2 (1)= 0,248 p>0,6 (29 females in clinicals and 31 in controls; 88 males in clinicals and 81 in controls). The groups did not differ in education years t(225)=0,947 p>0,3. The groups did not differ in the attachment styles chi2 (2)= 4,20 p>0,7. Manova variance analysis revealed significant main effect of group factor F(1,217)= 60,5 p< 0,005, higher depression in cancer patients (mean= 15,37) than in controls (mean 6,50); significant main effect of attachment style factor F(1,217) = 7,14 p< 0,002, higher depression in the anxious-ambivalent subjects (mean= 13,65) than in the secure ones (mean= 8,15); significant interaction between two factors F(1,217)= 5,23 p< 0,007, higher depression in the attachment styles in lung cancer patients (secure 10,76; avoidant 14,27; ambivalent 21,04) than in controls (secure 5,5; avoidant 7,75; ambivalent 6,27). Correlational analysis indicated that the secure style is favourable for weaker depression of patients (Pearson's r= -0,27 p< 0,01), but the anxious-ambiwalent style for stronger depression (Pearson's r= 0,43 p< 0,01). The avoidant style did not correlate significantly with depression neither in healthy (Pearson's r= 0,07 p> 0,1) nor affected by the disease subjects (Pearson's r= 0,01 p> 0,1)., Conclusions: the secure or the avoidant style may protect lung cancer subjects before operation from excessive reacting with depression but the anxious-ambivalent style may be a risk factor for maladaptive emotional reacting with depression.

The aim of study was to evaluate the influence of sex hormones: estradiol (E), follicle-stimulating hormone (FSH), progesterone (P), testosterone (T), dehydroepiandrosterone (DHEA-S) and cortisol (F) on the serum homocysteine concentration (HCY) in 40 premenopausal (group M) and 80 postmenopausal (group K) women. The influence of E2 therapy (ET) on the serum HCY level in the women with surgical menopause was also estimated. The plasma HCY concentration in the group M was significantly higher that in group K. After ET serum HCY level decreased significantly. No correlations were found between serum HCY and E2 concentrations in the all groups. No correlations were observed between HCY and FSH, P, T and F concentrations in pre-and postmenopausal groups. There was a significant negative correlation between serum HCY and DHEA-S concentration in group K. This result may indicate, that high level of DHEA decreases HCY concentration. There was no correlation in group M, where the mean concentration of DHEA was lower than in group K. The results of study indicate, that menopause increases and ET decreases plasma HCY concentration. DHEA-S may inhibit plasma HCY concentration in premenopausal women. More studies are needed to elucidate these hypotheses.

The purpose of this study was to look for effects of attachment styles for emotional reacting with depression in 117 lung cancer patients who were undergoing surgery during hospitalization and six weeks later. All subjects were classified according to their attachment style (secure, avoidant, ambivalent) assessed by means of the instrument based on Hazan and Shaver's (1987) descriptions of how people typically feel in close relationships. The Beck Depression Inventory was used to measure depression. Anova variance analysis revealed higher level of depression in anxious-ambiwalent style than in the secure style or the avoidant style during hospitalization. Six weeks later higher level of depression was in the anxious-ambivalent subjects than in the secure. The avoidant style took the middle position and it did not differ with the level of depression from others. The results indicate that the secure or the avoidant style may protect lung cancer subjects from overreacting with depression during hospitalization, but the anxious-ambivalent style may increase the depression level. After the return home the insecure styles may react with stronger depression and the secure style with weaker depression.

The aim of our work was the retrospective evaluation of thyroid function in patients with organic lesions of hypothalamo-pituitary system. In the group of 57 examined patients (31 females and 26 males), 43 were affected by pituitary adenomas, in the other patients organic lesions were caused by other tumors of central nervous system (2), tuberculosis (3) developmental or vascular disorders (5), nonspecific inflammation (1). Pituitary tumors (predominantly macroadenomas) were the cause of acromegaly in 14 cases, Cushing's disease in 9 and hyperprolactinaemia in 5. Next 14 subjects, were affected by nonsecreting pituitary tumors with a visual-field defects or different level of hypopituitarism and diabetes insipidus hypothalamo-hypophyseal. In 6 persons clinical manifestations of hypothyroidism with a low level of free thyroxin and normal TSH were observed. Surgical cure with transsphenoidal or transcranial operation was performed in 54 patients. Next 23 of the patients had lowered thyroxine level as a consequence of surgery. Considering the whole 57 person group with organic lesions of the hypothalamo-pituitary system, 29 patients (50.8%) were affected by secondary or tertiary hypothyroidism as a result of sellar and parasellar area illness or their surgical treatment. We didn't observe any correlation between TSH and FT4 in the patients with normal or low plasma FT4 levels. (1) secondary or tertiary hypothyroidism is a common consequence of organic lesions of the sellar and parasellar area or is due by their surgical treatment; (2) laboratory examination of thyroid function in these patients can not be evaluated only by TSH assessment, but also by thyroid hormone plasma level estimation because of the disturbances in thyroid an hypothalamo-pituitary system feedback.

We have described a case of a rare autoimmune disease, called autoimmune polyglandular syndrome type I (APS type I), in a 44-year-old woman. APS type I is an autosomal recessively inherited disorder, connected with mutations in AIRE (autoimmune regulator) gene. Subsequently, autoantibodies directed towards tissue-specific enzymes are produced, which causes destruction of multiple tissues and organs, first of all--endocrine glands. In the described woman, primary hypoparathyroidism occurred in childhood. Addison disease, chronic candidiasis of the nails and vitiligo developed in adolescence. Before she was 30, a premature ovarian failure, and axilla and pubis alopecia occurred. The last recognized disorders were cholelithiasis and candidiasis of oesophagus. The late diagnosis resulted in numerous complications of the disease and the patient's life quality impairment.

The article presents data concerning pseudohypoparathyroidism (PH TP). It is an unusual disease, which is characterized by the resistance of bones and kidney to PTH, followed by hypocalcaemia, hyperphospha-taemia, glandulary hypertrophy and hypersecretion of PTH. Patients with PTHT clinically manifest tetany seizures, soft tissue calcifications and many congenital malformations. The disease has a genetic etiology, it is connected with chromosome X and more often found in women. Clinical symptoms may be different and depend on genetic defect or its selectivity with reference to the tissues. At present we can distinguish three types of PHPT and pseudo-pseudo-HPT. The disease usually appears in the infancy. Early diagnosis and vitamin D3 or calcium treatment seem to be the most important for patient's condition. Too late treatment threatens with brain calcification followed by neurological defects and mental retardation. The long-lasting effect of PTH in bones can lead to their destruction, if bone receptors are completely sensitive.

The aim of analytical investigation included in this paper was the determination the nitrate and nitrite contents in 8 common vegetables: cabbage, carrot, parsley, potato, garden beet, cucumber, lettuce and radish in relation to the acceptable levels of nitrates. The samples of vegetables were taken from detail shops in Wrocław in the years 1996-1997. A total of 151 samples of vegetables were analyzed. The nitrate and nitrite level was determined collorimetricaly with sulfanilic acid after previous reduction of nitrates to nitrites by means of cadmium column. The acceptable values of nitrates were exceeded in 82% of the samples of radish and in 65% samples of lettuce. The smallest amount of samples with excess of the acceptable nitrate levels were found in potato, carrot and cucumber. It was found, that the nitrate content in the greenhouse vegetables: lettuce, cucumber and radish was greater than in the field vegetables. The potato, cabbage and carrot investigated after winter storage comprised lower content of nitrates than in freshly harvested. Nitrite accumulation in investigated vegetables was low, but the highest concentrations were found in lettuce and radish form greenhouse.

Etiopathogenesis of the polycystic ovarian disease is not clarified. Therefore, optimum therapy of hyperandrogenic syndromes, menstrual and fertility disorders pose a difficult problem. Sequential therapy with estrogens and progestagens is of value in young women, who are not planning to conceive in order to reduce hirsutism and regulate menses. A reduction of hirsutism, acne and seborrhea is produced within 3 months. However, cessation of the treatment produces the symptoms of excessive androgen production. Another method is therapy with antiandrogens, especially cyproterone acetate. This drug inhibits androgens biosynthesis and has also peripheral activity. Spironolactone is another antiandrogen frequently used, but it is known as a primarily diuretic agent. It acts primarily at the androgen receptor sites. Other antiandrogens such as ketoconazole and flutamide are used less frequently. It has been shown, that cimetidine--known H2 receptor inhibitor--also decreases the symptoms of hyperandrogenism. However, cimetidine has not been used for the treatment of polycystic ovarian disease. In cases of enzymatic defects in adrenocortical steroido-synthesis glucocorticoids are used, mainly low doses of triamcinolone and dexamethasone. Other therapies are preferred in case of polycystic ovarian disease in women, who want to conceive. Clomiphene citrate and gonadotropins, mainly FSH, are used to induce ovulation. If pharmacotherapy does not produce ovulation, wedge resection of the ovaries must be performed.

The content of cadmium and lead was measured in vegetables, fruit, cereals and soil from areas exposed and non-exposed to industrial pollution and in vegetables and soil from greenhouses. The elements were measured after dry mineralization by atomic absorption spectrophotometry following extraction of complexes from APDS into the organic phase (MIBK). Lead and cadmium were determined in 482 samples of vegetables, 101 fruit samples, 132 cereal samples and 297 soil samples. In the vegetables from the areas not exposed to industrial pollution lead content was below the detectability range (< d.r.) to 576.1 micrograms/kg, and cadmium was from < d.r. to 73.5 micrograms/kg. In the vegetables from areas exposed to industrial pollution lead was from 9.3 to 1044.0 micrograms/kg and cadmium from < d.r. to 552.3 micrograms/kg and cadmium from 2.3 to 132.5 micrograms/kg. In the soil from greenhouses lead was found in amounts from 17.5 to 212.0 mg/kg of air dry mass (adm), and cadmium from 125 to 750 micrograms/kg of adm. In soil from vegetable gardens lead was from 3.3 to 15.3 mg/kg of adm., and cadmium from < d.r. to 385.0 mu/kg adm. In soil from orchards lead was from 2.8 to 141.3 mg/kg adm, and cadmium from < d.r. to 810.0 micrograms/kg adm. In the soil from fields of cereals lead was from 3.0 to 67.5 mg/kg amd, and cadmium from < d.r. to 295.0 micrograms/kg adm. In fruit lead was present in amounts from 12.8 to 144.0 micrograms/kg and cadmium from < d.r. to 42.0 micrograms/kg. In cereals lead was found in amounts from < d.r. to 760.0 micrograms/kg and cadmium from < d.r. to 200 micrograms/kg.

The content of copper and zinc was determined in vegetables, fruit and cereals derived from areas exposed or non-exposed to industrial pollution and from greenhouses. The elements were determined after dry mineralization by atomic absorption spectrometry immediately from mineral solution. Copper and zinc were measured in 506 samples of vegetables, 101 fruit samples and 117 cereal samples. In the vegetables from areas not exposed to industrial pollution the copper content was from 0.10 to 6.69 mg/kg, and zinc content was from 1.10 to 27.90 mg/kg. In the vegetables from areas exposed to this pollution copper was found in amounts from 0.10 to 3.26 mg/kg and zinc from 0.88 to 27.90 mg/kg. In the vegetables from green-houses copper amounted to 0.14-1.20 mg/kg and zinc from 1.00 to 10.60 mg/kh. In fruit samples copper was found in amounts from 0.04 to 7.01 mg/kg and zinc from 0.60 to 17.30 mg/kg. In cereals copper ranged from 1.14 to 11.68 mg/kg and zinc from 7.20 to 72.07 mg/kg. Table I. Copper in vegetables, fruit and cereals from areas differing in the degree of industrial pollution and from greenhouses copper amounted to 0.14-1.20 mg/kg and zinc from 1.00 to 10.60 mg/kh. In fruit samples copper was found in amounts from 0.04 to 7.01 mg/kg and zinc from 0.60 to 17.30 mg/kg. In cereals copper ranged from 1.14 to 11.68 mg/kg and zinc from 7.20 to 72.07 mg/kg. Table I. Copper in vegetables, fruit and cereals from areas differing in the degree of industrial pollution and from greenhouses.

On the basis of observation of personal cases the authors discuss the clinical course and the natural history of Leber's disease. Particular attention is called to the diagnostic difficulties; the value of the angiographic examination in the acute phase of development of the condition is stressed. An appropriate differential diagnosis enabled us to avoid in these patients unnecessary and iatrogenic neuro- and radio-diagnostical examinations. Possibilities of treatment and the aspects of activity of this disease are also discussed.

Phenazone elimination test, as a marker of metabolic efficiency of the liver, was carried out in 11 hypothyroid patients. 20 hyperthyroid patients, 10 persons after hyperthyroidism treatment and in 20 healthy persons as a control group. In hyperthyroid patients the acceleration, and in hypothyroid patients the delay of phenazone elimination, in comparison with a control group was observed. Moreover, the impairment of phenazone gastrointestinal absorption was shown in hypothyroid patients and in persons after hyperthyroidism treatment. Similar alterations may be expected in persons with thyroid dysfunctions to whom the drugs with pharmacokinetic properties similar to phenazone are administered.

The authors describe the application of Akt -30 Aktograf apparatus designed by the branch of the Centre of Medical Technique in Bia ł ystok for recording extrapyramidal involuntary movements, cerebellar dyssynergia and clonic movements.