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Along with the growing epidemic of overweight the risk of atherosclerosis, cardiovascular disease morbidity and mortality are increasing markedly. Metabolic syndrome (MS) is a condition clustering together several risk factors of those complications such as visceral obesity, glucose intolerance, arterial hypertension and dislipidemia. The risk of obesity in acute lymphoblastic leukemia (ALL) survivors is higher than in general population. We aimed to assess (1) the relationships between chosen adipokines and neuropeptides, chemotherapy, CRT, and body fatness and (2) evaluate adipokines and neuropeptides concentrations as a new markers of MS in children. We conducted cross-sectional evaluation of 82 ALL survivors (median age: 13.2 years; range: 4,8-26,2; median time from treatment: 3.2 years), including fasting laboratory testing: peptides (leptin, GLP-1, orexin, PYY, apelin), total cholesterol and its fractions, triglycerides; anthropometric measurements (weight, height), systolic and diastolic blood pressure. We estimated percentiles of body mass index and percentiles of blood pressure. Between 82 survivors overweight and diastolic hypertension was diagnosed in 31% of patients (35% in CRT group) and 15% respectively. At least one abnormality in lipids concentrations was found in 43%. Girls were more affected than boys. Statistically significant increased in leptin and apelin concentrations and decreased in soluble leptin receptor concentrations in the overweight group were observed compared to the non overweight subjects. Significant increase in orexin levels in females who had received CRT compared to those who had not received CRT was found. CRT is the main risk factor of elevated of body mass among survivors of childhood leukemia. Dyslipidemia and hypertension, along with increased adiposity indicate higher risk of MS development. Girls are more affected than boys. Leptin, orexin and apelin seem to be good markers of increased adiposity especially after CRT. Higher leptin levels may be related to central resistance to those peptides. Survivors of childhood acute lymphoblastic leukemia should be screened for markers of the metabolic syndrome.

Approximately 20% of adolescents and children in Europe are overweight, and 30% of those who are overweight actually fulfill the criteria of obesity (Branca et al. 2007). The prevalence of obesity in survivors of acute lymphoblastic leukaemia (ALL) is 16 to 57% (Gregory and Reilly 2004). Among others, cranial radiotherapy (CRT) and genetic factors have been implicated as risk factors of overweight/obesity (Ross et al. 2004; Chow et al. 2007). The fat mass and obesity associated gene (FTO) has been recently found to contribute to the risk of obesity. Polymorphism of rs9939609 T>A was associated with an increased BMI in children aged ≥7 years. Individuals homozygous for A allele at rs9939609 constituted 16% of the population and population risk was 20.4% for obesity and 12.7% for overweight (Frayling et al. 2007). The high-risk FTO haplotype yielded a proportion of attributable risk of 22% for uncomplicated obesity in adults and children of European ancestry (Dina et al. 2007). Therefore, the influence of rs9939609 T>A polymorphism of FTO gene on overweight in leukaemia survivors was studied. A total of 191 patients were genotyped for the above genetic variant. Significant negative association between the rs9939609T allele and prevalence of overweight status was found in a subset of patients treated with CRT. Patients who receive CRT and are carriers of this variant may be protected from becoming overweight.

The observation of natural course of aortic valvae stenosis (AVS) in patients with high lipoprotein (a) [Lp(a)].60 AVS patients who did not agree for operational treatment were divided into group A (n = 19) with high serum Lp(a) level and into group B (n = 41) with normal plasma Lp(a) level.Plasma Lp(a), total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-alpha) as well as titers of immunoglobulin (Ig) class G, A, M against chlamydia pneumoniae were measured every 12 months. Echocardiographic evaluation of aortic valve was also done every 12 months.Means serum CRP at 12 month was higher in group A. Mean serum TNF-alpha level was also higher at visit I and at 12 month (visit II) in group A. Mean serum IL-6 level did not differ between groups. IgG titer was higher in group A at visit I and visit II. At 12 month of observation HDL-cholesterol plasma level was lower in group A. HDL/total cholesterol ratio as well as HDL/LDL-cholesterol ratio was laso lower in group A at 12 month of observation. No statistically significant differences in echocardiographic parameters were founf between groups.The results may suggest risk factors similarity of AVS and atherosclerosis.

Comparison of echocardiographic findings in AVS patients with and without hypercholesterolemia during 12 months' observation of AVS natural course.60 AVS patients who did not agree for operational treatment were divided into group A (n = 47) with high serum total cholesterol and into group B (n = 13) with normal plasma cholesterol.plasma total cholesterol, HDL-cholesterol, LDL-cholesterol, tri-glycerides and lipoprotein (a) were measured every 12 months and echocardiographic evaluation of aortic valve was also done every 12 months.Means total cholesterol did not change in group A, while increased in group B. HDL-cholesterol decreased in group A and LDL-cholesterol increased in group B. Mean TG and Lp(a) levels did not change in both groups. Increase in AOG max and AOG mean as well as V max were found only group A. LVPW syst increase was found in group A. LA diameter increased and AVA decreased only in group A.The results may suggest risk factors similarity of AVS progression and atherosclerosis.

In the last few years much attention is being given to the problem of diabetes mellitus, to it's development, prevalence and progression of chronic complications. The aim of the study was to 1. evaluate correction of metabolic disturbances in patients with long-term type 1 diabetes mellitus; 2. evaluate occurrence of diabetic nephropathy and excretion function in patients with long-term type 1 diabetes mellitus; 3. evaluate function of the cardiovascular autonomic nervous system in patients with long-term type 1 diabetes mellitus; 4. search for connections between the type and change dynamics in the cardiovascular system and degree of diabetic nephropathy advancement. The study was performed in a group consisting of 31 patients with type 1 diabetes mellitus (20 women, 11 males). Mean age of the study group equaled 37.6 +/- 10.75 years, duration of diabetes mellitus 21.3 +/- 9.55 years. Concentration of cystatin C in the study group was 0.98 +/- 0.23 ng/ml, in the group of patients with diabetic retinopathy 1.13 +/- 0.30 ng/ml, while in the group without diabetic retinopathy 0.89 +/- 0.13 ng/ml. Concentration of cystatin C (p0.05) and calculated GFR according to equations proposed by F.J. Hoeck [GFR/1.73 m2 = -4.32 + 80.3/plasma cystatin] (p0.01) also G.D. Tan [GFR -10 = (87.1/plasma cystine) - 6.87] (p0.01) significantly differentiated the discussed groups.despite normal levels of blood creatinine in the studied patients, decreased glomerular filtration was calculated for plasma cystatin C. Plasma cystatin C concentrations and calculated glomerular clearance significantly differentiated the group with retinopathy from the group without diabetic retinopathy. Determining cystatin C concentrations as a protein which probably does not undergo glycation in plasma, may play a role in the detection of early diabetic nephropathy, when as well as plasma creatinine levels and albumin/creatinine index calculated from a sample of morning urine do not differentiate the studied group of patients.

Neuropathy, one of the most common diabetes complications, is characterized by highly variable clinical picture. It is not established what evaluation scheme should be applied in the assessment of patient regarding diabetic neuropathy. The validity of various laboratory tests in the diagnosis of diabetic neuropathy also remains unclear. This paper describes different clinical manifestations of diabetic neuropathy and presents the most important methods of assessment of patients with neuropathy suspected based on literature data and authors' observations. Authors highlighted the implications of different methods in diagnostic process. The most valid methods include physical evaluation, determination of vibration sensation and assessment of nerve conduction velocity. The autonomic functions tests have a special role allowing for the diagnosis of autonomic neuropathy.

Presented has been contemporary knowledge on diabetes gravidarum diagnosis and treatment.

It is difficult to establish predictors for diabetic neuropathy because no generally accepted criteria of its diagnosis exist. In previous investigations risk factors profiles for neuropathy differ markedly. The aim of this study was to assess risk predictors for diabetic neuropathy in relation to different criteria of its diagnosis. Ninety-five diabetic patients entered the study. The exclusion criteria included uremia, alcohol abuse and radiculopathy. Control group consisted of 43 healthy volunteers. All patients underwent the clinical assessment, instrumental evaluation of superficial and deep sensation, tests of cardiovascular autonomic function and nerve conduction studies. According to the performed assessment patients were classified into following groups: without neuropathy, suspicion of neuropathy, neuropathy confirmed in clinical examination, neuropathy confirmed in electrophysiological testing, autonomic neuropathy. Analysis showed that the most important predictors in patients with subjective symptoms were type 2 diabetes mellitus, diabetes duration and age of patients. When neuropathy was diagnosed according to the clinical examination, predictors included type 2 diabetesmellitus and duration of the disease. In the cases of neuropathy confirmed by electrophysiological studies and autonomic neuropathy, only diabetes duration appeared to be a significant predictor. Our study demonstrated that predictors for diabetic neuropathy varied in relation to different diagnostic criteria and where the most important predictor for all forms of neuropathy is duration of diabetes. This result indicates the need for frequent screening tests in patients with long duration of the disease, irrespective of its metabolic control, patients' age or type of diabetes.

Despite of dramatic improvement in diagnostic procedures and treatment of diabetic patients, cardio-vascular complications are still the most frequent causes of death in these patients. Diabetes influences myocardial and coronary vessels function by coexisting macroangiopathy, microangiopathy, metabolic disturbances and autonomic nervous system neuropathy. All these factors result in diastolic and systolic dysfunction of the heart. Cardiomyopathy, congestive heart failure and serious arrhythmias are the end stage of diabetic complications. Macroangiopathy demonstrates accelerated atherosclerosis (involving coronary arteries), which consequences can be observed in 1 type diabetes patients at around the age of 30. Causes of increased risk of macroangiopathy in type 1 diabetic patients are not clear. There are not many clinical, prospective trials which can allow for etiology determination of the increased incidence of atherosclerosis and mortality due to coronary artery disease in this population. Adding to traditional risk factors of atherosclerosis like genetic factors, hypertension, dyslipidemia, obesity, smoking and improper diet, other important risk factors are observed in diabetic patients. Only few clinical trials suggest that hyperglycemia, glycation, glycoxidation of proteins, lipoproteins, changes in their composition, microalbuminuria, coagulation, fibrinolytic disturbances are additional risk factors of endothelium dysfunction and atherosclerosis. Prevention and treatment of accelerated coronary artery disease and it's consequences are more complicated in the diabetic population than in others. Some of the clinical trials suggest that even improved glycemic control does not eliminate the elevated risk of coronary artery disease in type 1 diabetic patients.