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Studies on bones metabolism regulation mechanisms leaded to discovery of RANKL/OPG/RANK signal system (receptor activator of nuclear factor kappaB ligand/osteoprotegerin/receptor activator of nuclear factor kappaB). It was found that beyond bone metabolism regulation Osteoprotegerin (OPG) is involved in some other processes: apoptosis, regulation of immunological system. Data from numerous studies performed in the last years indicate potential association between OPG and cardiovascular pathology. OPG was identified as atherosclerosis marker. Molecular mechanism by which OPG exerts its atherogenic effect is not fully elucidated.

The aim of this study was to investigate the relationship between a sub-population of endothelial progenitor cells (EPC), namely colony-forming unit-endothelial cells (CFU-EC), their colony-forming capacity and variable clinical parameters, including insulin resistance and oxidative stress, in obese individuals. Thirty-eight obese adults (aged 42.5 ± 12.7), with BMI 32.3 ± 4.0 and 13 normal-weight controls (aged 48.2 ± 12.9; BMI 23.2 ± 2.3) were studied. CFU-EC colony-forming capacity was impaired in the group of obese individuals compared to the normal-weight controls (P = 0.001). The inverse correlation between homeostasis model assessment-insulin resistance (HOMA(IR)) index and CFU-EC number (r = -0.558, P < 0.0001) as well as positive total antioxidant status of plasma (TAS)/CFU-EC relation were noticed during the study. Additionally, correlations between the concentration of triglycerides (TG), high-density lipoproteins (HDLs), and body composition parameters in the obese participants were established. Our results demonstrate that insulin resistance and oxidative stress have a significant impact on the CFU-EC colony formation in obesity. Moreover, in multivariate regression analysis, in both studied groups, the HOMA(IR) index and HDL concentration were independent predictors of the number of CFU-EC. Endothelium dysfunction, which can be present in obesity, may in part be caused by EPC function impairment in this condition.

Inadequate minerals intake, as well as disruption of some metabolic processes in which microelements are cofactors, are suggested to lead to the development of hypertension. The role of minerals in the pathogenesis of hypertension still remains to be explained. In the present study, we sought to determine associations between serum and hair mineral concentrations and serum lipids and glucose levels. Forty obese hypertensive subjects with insulin resistance and 40 healthy volunteers were recruited in the study. Blood pressure, BMI, and insulin resistance were recorded in all subjects. Levels of lipids, glucose, sodium and potassium, iron, copper, zinc, magnesium, and calcium were assessed in serum. Iron, copper, zinc, magnesium, and calcium were assessed in hair. Dietary intake of the analyzed minerals was estimated. We found distinctly higher concentrations of serum iron and serum and hair calcium as well as markedly lower levels of hair zinc in the hypertensive subjects. The study group manifested also significantly lower daily intake of calcium, magnesium, and iron. We observed a relationship between the concentrations of iron, zinc, and copper in serum and hair and high and low range of cholesterol, triglycerides, and glucose serum levels in the studied patients. Moreover, this study demonstrated significant correlation between serum and hair concentrations of selected minerals and their dietary intake and levels of serum lipids and glucose and blood pressure in the study and the control groups. The obtained results seem to indicate the association between lipid and glucose metabolism and iron, copper, zinc, and calcium concentrations in blood and hair of hypertensive and obese patients with insulin resistance.

Objective: Glycosylated hemoglobin (HbA1c) and resistin may be influenced by diabetes, but their associations remain unclear. We hypothesized that serum resistin might be parallel to Hb1c., Design and Setting: We measured serum resistin in 134 obese non-diabetic (73 women and 61 men), and 65 obese diabetic (33 women and 32 men) humans, and examined their relationships with HbA1c. The presence of diabetes was the only differentiating factor between the groups., Results: Resistin, non-diabetic vs. diabetic, median and interquartile range, respectively: resistin (ng/mL) 26.08, 16.09 and 22.14,14.54, p>0.5. To investigate the influence of HbA1c on resistin, both groups were divided into tertiles based on HbA1c. In diabetics, resistin was similar in high, intermediate, and low HbA1c subgroups, p>0.05, and resistin was not influenced by HbA1c: r=-0.1785; p=0.15. In non-diabetics, resistin differed between HbA1c tertiles, p<0.001, and was influenced by HbA1c, r = -0.3599; p=0.0003., Conclusions: Resistin concentrations are similar in diabetic and non-diabetic humans with the same range of obesity. However, resistin is associated with HbA1c only in non-diabetic obese individuals which may point to the fact that resistin is a marker of glycaemic balance in obesity but not in diabetes.

Excessive body mass and sedentary lifestyle are well-known factors for cardiovascular risk, which when present in the young population may have significant health consequences, both in the short- and long-term. The aim of the study was to evaluate the prevalence of overweight, obesity, and sedentary lifestyle in two teenage populations living in an urban or rural area. An additional aim was to compare their physical activity. The study was designed and conducted in 2009. The study population consisted of 116 students aged 15-17 years - 61 males (52.7%) and 55 females (47.3%), randomly selected from public junior grammar schools and secondary schools in the Poznań Region. There were 61 respondents from a rural area - 32 males (52.5%) and 29 females (47.5%), whereas 55 teenagers lived in an urban area - 29 males (47.5%) and 26 females (47.3%). Students were asked to complete a questionnaire, which was especially prepared for the study and contained questions concerning health and lifestyle. A basic physical examination was carried out in all 116 students, including measurements of the anthropometric features. Calculations were performed using the statistical package STATISTICA (data analysis software system), Version. 8.0. When comparing these two populations, no statistically significant differences were detected in the ratio of weight-growth, with the exception of the fact that the urban youths had a larger hip circumference (97.1 v. 94.3 cm, p<0.05). In the group of urban students there were also significantly more subjects with excessive body weight (27.3% v. 24.6%, p<0.05), with a predominant proportion of obese students (60%). There were significantly more male obese individuals (66.7%). In the population of rural teenagers, obesity rate did not differ statistically significantly from the percentage of overweight (11.5% v. 13.1%, p>0.05), the problem of excessive weight affected both sexes in a similar proportion (25% boys and 24.1% girls, p>0.05). In this paper it is shown that there were differences concerning physical activity of teenagers living in urban and rural areas. Urban students much more often declared an active lifestyle (72.7% v.42.6%, p<0.05), used a variety of additional forms of activity (not counting compulsory physical education classes).

In 1997 World Health Organization regarded obesity as an illness caused by modern civilization. Elevated values of BMI index over 30 kg/m2 increase the risk of movement organ diseases. Growing ailment pains in lumbar part of vertebral column and disfunction of its joints leads to severe disability. Many studies revealed, that BMI > 30 kg/m2 increased the risk of joints injuries up to 4-5 times. Most common cause of back pain and knee pains, amount obese patients, seems to be a degenerative disease. Finn studies prove correlation between visceral obesity index (waist/hip ratio) and intensification of pain in lower part of vertebral column. Women were suffering more often than men, 39.5% vs 31.2%. Amount causes of individual degeneration changes the most common is "overloaded mechanism". Nowadays, scientists claim, that subclinical inflammatory process might be connected with obesity. Fat tissue is a source of many adipocytokines. Such adipocytokines as leptin, resistin, adiponectin and proinflammatory cytokines such as IL-6, IL-1, IL-8, TNF-alpha, IL-18 and hsCRP modulate inflammatory process and lead to damage of joint cartilage. Other cytokine, like osteoprotegrin, exerts osteo-protection impact. The reduction of body mass index seems to be necessary as far as patients with joints and vertebrae bone illnesses are concerned. That aim might be achieved by excessive physical activity and proper diet. Physical training should be fitted individually to every patient. Static and endurance training are not recommended. Proper weight loss should be more less 1 kg per week, and general physical ability improves. Cooperation between obesitologists and orthopedists seems to be necessary.

Unlabelled: Obesity epidemics is a growing medical problem all over the world. Obesity is an independent atherosclerosis risk factor. Commonly known risk factors don't fully explains increased coronary artery disease risk in this group of patients. One of the potential mechanisms responsible for the direct influence of obesity on atherosclerosis progression is impaired oxidation-antioxidation balance estimated by TAS (Total Antioxidant Status). The aim of study was to evaluate the regular physical activity influence on oxidative stress activity in women with simple obesity., Material and Methods: 20 women with simple obesity, aged 23-65 years, were studied. All of them underwent a 6-month physical activity programme under the observation of a physiotherapist. Before and after the programme TAS, lipid profile and C-reactive protein concentration were assessed., Results: After 6 months of the physical therapy programme a significant increase of TAS was found. Favorable changes in biochemical parameters were accompanied by decrease of waist circumference. Positive correlation between change in waist circumference and change in TAS was observed., Conclusions: Obesity in women increases inflammatory process activity. Regular physical activity favorably influence lipids parameters and blood pressure. Regular physical activity in obese women increases total antioxidant capacity, mainly related to waist circumference reduction.

Objectives: Glycosylated haemoglobin (HbA1c), leptin, leptin soluble receptors (sOB-R) and free leptin index (FLI) may all be influenced by diabetes, but their associations remain unclear. Therefore, we put forward a hypothesis that serum leptin, sOBR and FLI might be parallel to Hb1c, as they all reflect the metabolic status., Design and Setting: We measured leptin and sOB-R concentrations in 97 obese non-diabetic (47 women and 50 men), and 65 obese diabetic (32 women and 33 men) humans, and examined whether they were related to HbA1c. Under the condition, the presence of diabetes was the only differentiating factor between two groups of frankly obese humans., Results: Non-diabetic vs. diabetic, median and interquartile range, respectively: Leptin (ng/ml), 30.83, 37.27 vs. 28.24, 23.34; p>0.05; sOB-R (ng/ml), 17.62, 17.05 vs. 21.81, 16.61, p<0.05; FLI, 231.23, 310.00 vs. 131.76, 157.68, p<0.05. To investigate the influence of HbA1c on leptin and sOB-R, both groups were divided into tertiles based on HbA1c. In diabetics, leptin did not differ between the high, intermediate, and low HbA1c levels subgroups, p>0.05, and leptin was not influenced by HbA1c levels: r=0.086; p>0.05. For sOB-R, respectively: p>0.05; r=0.080; p>0.05. In non-diabetics, respectively: p<0.05; r=0.2923; p<0.05 for leptin; and p<0.0001, r=0.5103; p<0.0001, for s-OB-R., Conclusions: Not leptin alone but serum sOB-R and FLI are the markers of leptin action impairment in type 2 diabetes. Further, HbA1c is not associated with metabolic status of leptin in obese diabetic patients, whereas this association is found in obese non-diabetic humans.

Objectives: Plasma cholesterol, triglycerides and serum resisistin may all be influenced by diabetes and obesity, but their associations remain unclear. Therefore, we put forward a hypothesis that serum lipids might be parallel to resistin, as they all reflect the metabolic status of obese humans., Design and Setting: We measured the concentrations of resistin, total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and triglycerides (TG) in 134 obese non-diabetic (73 women and 61 men) and 65 obese diabetic (33 women, 32 men) humans, and examined their interrelations. Obesity was defined according to the WHO criterion (BMI, ≥ 30 kg/m²) The presence of diabetes was the only differentiating factor between two groups of frankly obese humans., Results: Non-diabetic vs. diabetic, median and interquartile range, respectively: resistin (ng/mL) 26.08, 16.09 vs. 22.37, 14.54, p=0.736; TC (mmol/L) 5.02, 1.39 vs. 5.16, 1.56, p=0.374; HDL-C (mmol/L): 1.10, 0.41 vs. 1.02, 0.47 p<0.05; LDL-C (mmol/L): 3.00, 1.05 vs. 3.00, 1.30 p=0.978; TG (mmol/L) 1.70, 1.43 vs.1.95, 1.81 p<0.05. To investigate the interrelations between resistin and lipids, a simple regression analysis was used, and the results were for resistin & TC, HDL-C, LDL-C, and TG, respectively: in the whole cohort r=-0.1364, p=0.0670, r=0.1514, p=0.0437, r=-0.2573, p=0.0006, r=0.0434, p=0.5597; in non-diabetics: r=-0.2067, p=0.0213, r=0.1023, p=0.2621, r=-0.2399, p=0.0083 and r=0.0288, p=0.7497; in diabetics r=0.0280, p=0.8360, r=0.2267, p=0.0929, r=-0.2933, p=0.0298, r=0.1349, p=0.3127., Conclusions: In diabetic and non-diabetic subjects the atherogenic LDL cholesterol shows an inverse correlation with resistin, whereas the protective anti-atherosclerotic HDL cholesterol is positively correlated with resistin.

Presented case report shows hypertriglycerydemia treatment problem in 26-year-old woman with 2 episodes of acute pancreatitis history. Very high serum triglycerides concentration and clinical symptoms suggested chylomicronemia syndrome with urgent need for treatment. After a course of several subsequent therapeutic plasmapheresis triglycerides significantly decreased. Safety and effectiveness of this method was confirmed.

This prospective and uncontrolled clinical study attempted to evaluate the effects of short-term supplementation with oily garlic formulation on lipid metabolism, glucose level and antioxidant status in patients suffering from primary arterial hypertension. Seventy subjects aged 30 to 60 years with primary arterial hypertension, including 38 females (mean age: 52.0 +/- 8.3 years) and 32 males (mean age: 48.6 +/- 8.2 years), took part in the study. In addition to receiving a standard antihypertensive pharmacotherapy they took 6 capsules of garlic preparation daily for 30 days. Before and after phytotherapy blood samples were collected to assay total cholesterol, HDL, LDL, triglycerides, lipid peroxidation products (TBARS) and vitamin A, C and E, beta-carotene, glutathione and glutathione peroxidase activity, and arterial blood pressure was measured. The analyzed garlic preparation was found to significantly lower lipid level and the level of lipid peroxidation products in the blood. It markedly increased vitamin E concentration in the serum, whereas the increases in the levels of other antioxidant vitamins and glutathione peroxidase activity proved insignificant. The product did not affect arterial blood pressure in the study subjects. The results of this study suggest that the investigated garlic preparation may be tentatively used as an adjunct agent in treatment of arterial hypertension because of its hypolipemic and antioxidant properties.

Objectives: Adiponectin is a novel plasma protein produced exclusively in adipocytes. Despite early data, its relationship with obesity and diabetes has been recently questioned. Since plasma lipids influence diabetes and obesity, of concern is whether any associations between plasma lipids and adiponectin exist., Design and Methods: The aim of this study was to measure adiponectin levels and to investigate their associations with plasma cholesterol fractions and triglycerides in 73 obese non-diabetic subjects (44 women and 29 men), and 43 obese diabetic subjects (28 women and 15 men), aged 52.7+/-11.2 and 53.1+/-11 years, respectively, and matched for age, sex and BMI. The WHO definitions of obesity and diabetes were used. Adiponectin was determined by an enzyme-linked immunosorbent assay., Results: No correlations between adiponectin and total and LDL cholesterol levels were shown (for the whole cohort: r=0.0130; p=0.8899, and r=0.0807; p=0.3958, respectively). A positive correlation between HDL cholesterol levels and adiponectin occured predominantly in obese women without diabetes (r=0.4531; p=0.0023), resulting in an overall statistical trend in the whole cohort (r=0.2243; p=0.0164). A negative correlation between serum adiponectin and triglycerides was found (r=-0.3413; p=0.0002)., Conclusion: Adiponectin correlated only with TG and partially with HDL but not with LDL and total cholesterol in the study group of obese diabetic and obese non diabetic subjects. In view of these results we suggest that the role of adiponectin in human metabolism is unclear and merits further investigation.

Chronic intestinal ischemia is a diagnostic problem for the physicians from internal department as well for the surgeons. The clinical manifestation of this disease is not clear and the symptoms are similar to many other disorders. This requires from the physician a wide knowledge and many-sided diagnostic process. The success depends also on the good cooperation between radiologist and vascular surgeon. The authors presents the case of 59-aged patient with occlusion of superior mesenteric artery. After the angioplasty there was a complete relief of ischemic symptoms.

Unlabelled: Arterial hypertension as well as metabolic syndrome lead to an inflammatory state which is probably responsible for the initiation and progression of atherogenesis. The aim of the study was to evaluate certain markers of inflammatory reaction in patients with hypertension and coexisting metabolic disorders and to examine correlations between grade of inflammatory process and metabolic and biochemical parameters., Materials and Methods: The study group comprised 44 patients with metabolic syndrome (group I) and 26 persons with hypertension accompanied by only one component of metabolic syndrome (group II). The control group consisted of 12 healthy volunteers. Serum concentration of tumor necrosis factor soluble receptor type 2 (sTNFR2), soluble intercellular adhesion molecule (sICAM 1) and fasting insulin were measured. Insulin resistance ratio (IRI/G) was calculated. Fat content was evaluated using bioimpedancy method., Results: Higher concentrations of sTNFR2 and sICAM 1 were observed in both studied groups when compared to the control group. In group I concentrations of both parameters were significantly higher in comparison with group II. The obese hypertensives with dyslipidemia presented higher concentrations of the studied cytokines than the slim ones, as well as the obese diabetic hypertensives with dyslipidemia when compared to non-diabetic ones. Finally, in case of diabetes accompanying other metabolic disorders, the concentrations of studied parameters were observed to be the highest. In patients with hypertension and visceral obesity and without diabetes positive correlations between sTNFR2 and %FAT insulin and IRI/G ratio were found., Conclusions: 1. Hypertension and other features of insulin resistance are associated with aggravation of an inflammatory process. 2. Aggravation of an inflammatory reaction in patients with hypertension is becoming more distinct along with increasing number of definable components of the metabolic syndrome. 3. It seems that diabetes mellitus contributes to aggravation of an inflammatory reaction. 4. Positive correlations between sTNFR2 and %FAT insulin and IRI/ G ratio can be considered as a basis for crucial role of TNF system in pathogenesis of insulin resistance in obese patients.

Unlabelled: The aim of this study was to assess the influence of trandolapril on blood pressure and ET-1 plasma activity in young patients with essential mild-to-moderate hypertension., Material and Methods: 19 persons with essential mild-to-moderate hypertension were enrolled into the study: the average age of this group was 17,6 +/- 1,4 years. The blood pressure and serum concentration of ET-1 in plasma were measured before enrolling and after 42 days of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA method., Results: In the studied group, after trandolapril therapy SBP was reduced from 142.6 +/- 9,7 mmHg to 129.3 +/- 8,4 mmHg (p<0,003), DBP from 85.7 +/- 6,9 mmHg to 79.8 +/- 8,6 mmHg (p<0,01). The average serum concentration of endothelin-1 was: before therapy 9,33 +/- 1,9 fmol/ml and after therapy 8,96 +/- 2,2 fmol/ml (non-significant)., Conclusions: 1. Young hypertensives treated with trandolapril (ACEI) showed significant decrease of SBP and DBP 2. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but without statistical significance.

Unlabelled: Adiponectin (APM1) is a protein produced in adipose tissue. The aim of this study was an assessment of the plasma APM1 concentration in patients with metabolic syndrome. We also analysed the possible correlation between APM1 and anthropometric and biochemical parameters., Material and Methods: There were 81 patients with metabolic syndrome recruited to the study. Patients were divided into following groups: group 1 - with hypertension, group 2 - with obesity, group 3 - with hypertension and obesity, group 4 - with hypertension, obesity and diabetes mellitus type 2. There was a control group consisting of 10 healthy volunteers. We assessed the range of insulin sensitivity using euglicemic metabolic clamp (Ferrannini/de Fronzo) and plasma APM1 concentration (RIA). In every patient the anthropometric and blood pressure measurements were done. Blood samples were taken to assess lipid profile and insulin concentration., Results: In group 1 and group 2 APM1 was statistically lower than in control group. In group 3 the APM1 concentration was the lowest. In a given group there was a correlation between APM1 and anthropometric parameters (BMI), lipid parameters (TAG, HDL) and blood pressure. The most visible correlation between APM1 and insulin sensitivity (M value in the clamp) was found in the group with hypertension and obesity., Conclusions: Hypertension is connected with lower APM1. Obesity and diabetes mellitus type 2 coexisting with hypertension lead to the farther lowering of APM1. Obesity is the strongest factor influencing APM1 concentration. The correlation between APM1 and M value emphasises the role of APM1 in pathogenesis of insulin resistance.

Unlabelled: Metabolic syndrome is a global epidemic problem. The latest studies revealed that metabolic syndrome can be associated with low-grade chronic inflammation which is postulated to play an essential role in the atherosclerotic process. The aim of the study was evaluation of selected acute phase proteins concentration in patients with metabolic syndrome., Material and Methods: 30 patients with metabolic syndrome were recruited to the study. The control group comprised 15 healthy persons. In all subjects assessment of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), alpha1-antichymotrypsin (ACT), ceruloplazmin (Cp), haptoglobin (Hp), alpha2-makroglobulin (alpha2-M), with use of rocket immunoelectroforesis method were performed., Results: In the group with metabolic syndrome concentration of the studied acute phase proteins significantly exceeded those observed in the control group. Positive correlations between BMI, waist circumference and CRP ACT, AGP, Cp, Hp were found., Conclusions: Metabolic syndrome is associated with increased inflammatory process. Visceral obesity is an important determinant of low-grade inflammation in metabolic syndrome. Increased inflammatory process observed in patients with metabolic syndrome should be considered as a potential factor in atherosclerotic process.

Unlabelled: Overexpression of chemokine receptors might contribute to the initiation of atherosclerosis, due to promotion of monocyte migration to the subendothelial space which is considered as an initiating mechanism in the natural history of atherosclerosis. The CCR5 receptor is one of the chemokine receptors present on peripheral T lymphocytes, monocytes and macrophages., Objective: The aim of the study was to determine the expression of CCR5 receptor on peripheral blood mononuclear cells (PBMC) in patients with type 2 diabetes., Material and Methods: 14 patients with type 2 diabetes and 6 healthy subjects as a control were included to the study. We evaluated the density of the CCR5 receptor on peripheral blood mononuclear cells by flow cytometric analysis by use of LSR Cytofluorograf System (Becton Dickinson Co.)., Results: There was significantly higher density of the CCR5 receptor on PMBC in diabetic subjects when compared to the controls., Conclusions: (1) Patients with type 2 diabetes present overexpression of the CCR5 receptor on peripheral blood mononuclear cells. (2). Overexpression of the CCR5 receptor should be considered as a factor that promotes the development of atherosclerosis in diabetic patients.

Metabolic syndrome occurs in about 25% of the adult population in industrialised countries. The pathogenesis of this syndrome is associated with insulin resistance. There are growing evidence that proteins produced in adipose tissue can play a role in development of insulin resistance. One of them is adiponectin (APM1), that circulates in human plasma at high level (5-30 microg/ml). A reduction in APM1 expression is closely associated with insulin resistance in animal models and in studies in humans. APM1 correlates with typical features of metabolic syndrome: BMI, WHR, total cholesterol, HDL, LDL and triglyceride levels, glucose, insulin, degree of insulin resistance in hyperinsulinemic-euglycemic clamp, blood pressure, hyperuricemia. There are some hypotheses that in the future therapy with APM1 may play a role in reversing insulin resistance in many disorders.

Background: Endothelin (ET) is the strongest endogenic substance causing vasoconstriction. The aim of this study was to assess the influence of ACEI therapy on serum concentration of ET-1 plasma activity in young patients with essential mild-to-moderate hypertension., Design and Methods: 19 persons with essential mild-to-moderate hypertension were enrolled into study (14 male and 5 female). The average age of this group was 17.6+/-1.4 years. The patients were untreated or there was a 7 day wash out period. The blood pressure and serum concentration of ET-1 plasma were measured before enrolling and after 6 weeks of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA methods., Results: In analyzed group there was a significant both SBP and DBP lowering after the ACEI therapy. SBP was reduced from 142.6+/-9.7 to 129.3+/-8.4 mmHg (p<0.003), DBP from 85.7+/-6.9 to 79.8+/-8.6 mmHg (p<0.01). The average serum concentration of endothelin-1 was: before treatment 9.33+/-1.9 fmol/ml and after therapy 8.96+/-2.2 fmol/ml., Conclusion: The treatment with ACEI drug (trandolapil) induced the significant decrease of SBP and DBP in young hypertensives. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but not statistically significant.

Unlabelled: It has been proved that effectiveness of monotherapy in mild hypertension is about 50%; in the other half of patients the dose of previously used drug should be increased or combined therapy should be recommended. THE AIM OF THE STUDY was to compare treatment with angiotensin convertase enzyme inhibitor--ACE-I (enalapril 10 mg bid--group 1) to therapy with ACE-I combined with calcium antagonist (enalapril 5 mg bid + nitrendipine 20 mg qd--group 2)., Material and Methods: In a prospective, open, randomised crossover study we assessed 44 hypertensive subjects (17 women, 27 men), aged 35-69 years (mean age 48.6 years) with poorly controlled hypertension treated with enalapril 5 mg twice daily. Mean initial systolic blood pressure was 150.8 < or = 9.9 mmHg, diastolic 94.7 +/- 5.3 mmHg respectively. The influence of the treatment regimen on the quality of life (QoL) was estimated by a questionnaire., Results: The effectiveness of both used procedures did not differ statistically--in both groups mean blood pressure reduction was similar (14/8 mmHg in 4 weeks), also percentage of patients with well controlled hypertension (about 50%) did not differ significantly. In the group with changes regimen from monotherapy to combined therapy the improvement of systolic blood pressure was found to be statistically significant (p<0.05); in the case of combined therapy replaced with monotherapy such an improvement was not observed. In the subgroup with the isolated systolic hypertension combined therapy was considerably more effective. The improvement of QoL was noted in both groups, mainly in the initial phase of the study., Conclusion: In mild hypertension ACE-I and calcium antagonist combination is effective in blood pressure reduction and in the improvement of the quality of life. Nitrendipine in a dose 20 mg in an once daily regimen is a potent and safe hypotensive agent, particularly in isolated systolic hypertension.

This study aimed to evaluate the influence of the tobacco smoking on taste sensitivity in healthy adults. The study involved healthy subjects, aged 30 to 60 years. The experimental group consisted of 28 smoking subjects; the control group consisted of 33 non smokers. The ability to recognize four basic types of taste and thresholds for detection of sweet and salty taste were determined in this study. The measurement of taste thresholds were carried out by electrogustometry. The obtained results have been found higher thresholds for detection of salty taste in smokers compared with control subjects (p<0.05). We estimated that such tastes as: sweet, salty, sour have been recognized by smokers weaker and their sensitivity of tongue receptors to electric stimulus was slightly lowered than nonsmokers.

The objective of this study was to evaluate the urinary albumin excretion and plasma biochemistry in patients with essential hypertension and impaired glucose tolerance. We studied 82 untreated patients (35 women and 47 men, mean aged 41 +/- 13) with mild to moderate hypertension. Body mass index (BMI) for study subjects was 29.1 +/- 5.0 kg/m2 and mean office blood pressure at entry was 152/97 mmHg. After an oral glucose tolerance test (OGTT) glucose, group was divided into impaired glucose tolerant (n = 16; IGT) and normoglycemic (n = 66; NormGLU) subgroups; patients with diabetes were excluded. 24-hour urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. The median UAE in the IGT group was 16.0 +/- 28.6 mg/day and in NormGLU group 7.2 +/- 10.7 mg (p < 0.01). The prevalence of microalbuminuria was higher in IGT group (37 vs 18%). In the IGT subgroup total cholesterol, triglycerides and systolic blood pressure were higher. The presence of impaired glucose tolerance in hypertensive patients is correlated with increased urinary albumin excretion, which indicates significant role of metabolic disorders in inducing microalbuminuria.

Unlabelled: The inflammatory process contributes to the development of atherosclerotic changes. The aim of this study was to evaluate concentrations of selected acute phase proteins (APP) and their glycosylation profile in hypertensive subjects. 92 hypertensive patients (53 men and 39 women, average age 45.1 yrs) were recruited to the study. Hypertension was proved to be essential, mild to moderate (mean blood pressure values were 141/87 mmHg). The control group comprised 75 healthy persons in comparable age. In all subjects assessment of C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), alpha 1-antichimotripsin (ACT), transferrin, alpha 1-antitripsin (rocket immunoelectrophoresis method) and C3c and C4c complement fractions (radial immunoelectrophoresis according to Mancini) were performed. Evaluation of glycosylation profile and reactivity coefficient (RC) for AGP were done by means of affinity immunoelectrophoresis with concanavalin A as a ligand (according to Bøg-Hansen). When compared to the control group hypertensive subjects had significantly higher C-reactive protein and interleukin 6 concentrations. Level of transferrin (negative APP--decreasing in the course of the inflammatory process) was statistically lower in the studied group. Hypertensive patients were also found to have elevated AGP-AC values proving acute character of the inflammatory reaction. The intensification of the inflammatory reaction was greater in the subgroup of hypertensive patients with unsatisfactory control of blood pressure., Conclusions: 1. Hypertension may evoke the acute phase reaction. 2. Quantitative and qualitative changes in acute phase proteins observed in hypertension prove that hypertension itself is an acute inflammatory condition. 3. Markers of acute phase response are particularly strongly expressed in smokers and subjects with insufficient control of blood pressure. The most probable factor leading to the enhanced acute phase response in hypertension is interleukin 6.

Unlabelled: Both hypertension and obesity are speculated to stimulate inflammation process., The Aim of the Study: Evaluation of selected inflammatory markers in obese hypertensives and estimation of their relationship to selected anthropometric and biochemical parameters. 32 patients with hypertension (group I), 34 patients with obesity and hypertension (group II) and 16 healthy volunteers (control) were studied. Percentage of fat content (%FAT) was estimated. Serum concentration of tumor necrosis factor (TNF-alpha), interleukins (IL-4, IL-6, IL-10), leptin, insulin were measured. Insulin resistance ratio (IRI/G) was calculated as an insulin: glucose ratio. Higher concentrations of TNF-alpha, IL-4, IL-6, IL-10, leptin, insulin, IRI/G ratio as compared to a control were found in both investigated groups. In group II higher TNF-alpha, IL-10, leptin, insulin and IRI/G as compared to group I were observed. In group II correlations between in (TNF-alpha) and BMI, %FAT, insulin, IRI/G ratio and SBP (systolic blood pressure) were found. BMI and TNF-alpha emerged as independent predictors of SBP., Conclusions: 1. Hypertension is associated with increased level of inflammatory markers. 2. Obesity can aggravate inflammation in patients with hypertension. 3. TNF-alpha should be considered as a potential player in the state of insulin resistance in obese hypertensives. 4. Both BMI and TNF-alpha emerged as independent predictors of SBP.

The aim of this study was to assess the influence of 3 hypotensive drugs on the metabolic disorders: dyslipidemia, insulin resistance, hyperuricemia. There were 39 patients aged 20-55, with mild-to-moderate essential hypertension. The patients with other serious diseases or treated earlier with cholesterol or uric acid lowering drugs were excluded. Patients were divided into 3 groups, each was treated during 8 weeks with one drug: gr 1--trandolapril (T), gr 2--felodipine ER (F), gr 3--rilmenidine (R). Glucose and insulin in oral glucose tolerance test, I/G proportion, serum lipids and uric acid were tested before and after therapy. The therapy did not influence lipid parameters: LDL, HDL, triglyceride. In the T group there could be observed a significant reduction of total cholesterol value. Examined drugs did not induce changes in serum carbohydrate. The significant reduction of serum uric acid could be observed only after F therapy. Analysed drugs are very useful in therapy of hypertension with metabolic disorders.

The aim of this study was to evaluate the influence of blood pressure variability and circadian rhythm on left ventricular mass and urinary albumin excretion rate (UAE) in patients with essential hypertension. 82 untreated patients (35 women and 47 men; mean age 41.1 +/- 13.7) were recruited to this study. Mean office blood pressure at entry was 152/97 mmHg. Ambulatory blood pressure monitoring (ABPM) was performed using an Medilog ABP recorder (Oxford). Blood pressure variability was estimated as the standard deviation (SD) of systolic and diastolic ambulatory blood pressure. Urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. Echocardiography was used to measure left ventricular mass and left ventricular mass index (LVMI). The median urinary albumin excretion for the whole group was 8.2 mg/day; in 18 patients (21.9%) microalbuminuria was present. Left ventricular mass index in a whole group was 109.1 g/m2; in 23 subjects (28.0%) left ventricular hypertrophy (LVH) was found. Patients with microalbuminuria as well as with left ventricular hypertrophy had higher office and 24 hour ambulatory systolic and diastolic blood pressure and higher systolic blood pressure variability. During ABPM 18 patients with absent nocturnal fall in blood pressure (non-dippers) were found; they did not display more frequent prevalence of target organ damage. Increased 24-hour blood pressure variability present in hypertensive subjects with both microalbuminuria and left ventricular hypertrophy may suggest that this phenomenon plays role in development of target organ damage.

67 year old patient with chronic heart failure and persistent atrial fibrillation had overdosed glycosides for several months. The symptoms of gastrointestinal system and nervous system appeared after long term therapy with toxic doses of glycosides. Originally depression was diagnosed based on the central nervous system disturbances. Even though overdose of glycosides was diagnosed the blood serum glycoside level was within the therapeutic limits. Based on the precise analysis of the data, it was concluded that the reason for normal blood serum glycoside level in this case was coexisting hyperthyreosis.

In this paper the stages and pathogenesis of diabetic nephropathy have been presented. Factors which influence blood rheology and hemorheologic abnormalities founded in diabetic patients have been reviewed. Attention was paid to the role of rheological parameters in initiating and progression of diabetic nephropathy. The possibilities of prevention of diabetic microvascular complications by influencing blood rheology have been presented.

Obesity is associated with increased incidence of cardiovascular diseases, insulin resistance, dyslipoproteinemia and cancer. The discovery of leptin in 1994 has provided a lot of new information about obesity. Leptin is a 167-amino acid peptide synthetized almost exclusively in adipose tissue. This hormone circulates in blood serum in both free and bound forms. The long isoform of leptin receptor is widely distributed in brain, whereas numerous short forms are also being present in peripheral tissues. Leptin acts by binding to the receptors in hypothalamus and altering a release of several neuropeptides, especially neuropeptide Y, regulating energy intake and expenditure. Apart from signaling energy reserves to the brain, leptin promotes hematopoiesis, influences pubertal development and contributes to the increase in arterial blood pressure. Leptin production regulation in humans is poorly understood, but appears to depend on the total body fat, changes in energy intake and serum level of several hormones. Despite the recent advances in the knowledge of both physiology and pathophysiology of leptin, several many important questions require further studies.

The effects of extracorporeal shock wave lithotripsy on glomerular and tubular renal functions were determined by serum beta2-microglobulin (Sbeta2m) and urinary beta2-microglobulin (Ubeta2m) estimations in patients with nephrolithiasis. Unilateral treatment was performed in all patients. Urinary and serum creatinine levels were determined according to the method of Yatzidis. Sbeta2m and Ubeta2m were measured by radioimmunoassay the day before ESWL, on the day of ESWL, and then 1, 2, 5, 7, 8, 9, 14, and 28 days after treatment. Creatinine clearance, hourly urinary beta2m excretion (Ubeta2m/h), and tubular reabsorption of beta2m (TRbeta2m) were calculated. After lithotripsy, significant increases in Ubeta2m, Ubeta2m/h, and TRbeta2m were found (p < 0.001), whereas Sbeta2m, serum creatinine, and creatinine clearance values remained unchanged. Ubeta2m, Ubeta2m/h, and TRbeta2m reached their pretreatment values within 7-9 days after ESWL. We concluded that ESWL does not affect the glomerular filtration rate; however, it leads to a transient proximal tubular dysfunction.

Objective: To determine whether the administration of acetylsalicylic acid (ASA, also known as Aspirin) differentiates patients with renovascular hypertension from those with essential hypertension, in order to provide a simple alternative to more expensive forms of diagnosis for this condition., Design: Trial of ASA test in patients with previously diagnosed essential and renovascular hypertension., Setting: Inpatient department of an academic health sciences centre in Poznan, Poland., Patients: Forty patients with essential hypertension and 21 patients with renovascular hypertension., Interventions: Patients were given an intravenous injection of ASA (10 mg/kg body weight), blood pressure was measured and blood was sampled and assayed for plasma renin activity (PRA) before and 30 minutes after the injection., Results: ASA infusion in patients with renovascular hypertension resulted in a decrease in PRA from 15.2 (standard deviation [SD] 12.4) ng/mL per hour to 7.2 (SD 9.8) ng/mL per hour, whereas in patients with essential hypertension the initial PRA was significantly lower before ASA administration and did not change afterward. In patients with renovascular hypertension, the mean systolic, diastolic and arterial pressure decreased significantly (p < 0.001) after ASA infusion, but these did not change in patients with essential hypertension. Based on the criterion of 4 mm Hg as a detectable decrease in mean blood pressure, the sensitivity of the ASA test was 95.0% and the specificity 82.5%; its positive predictive value was 74% and its negative predictive value 97%., Conclusion: The precise measurement of blood pressure during the ASA test may provide a useful method of differentiating between patients with renovascular and essential hypertension.

Two groups of hypertensive patients: 137 responsive (on one or two drugs) and 162 resistant on antihypertensive treatment in the similar age were compared. Resistant patients (on three or more drugs) characterize by significantly higher body weight and BMI, longer history of hypertension, more frequent hypertension prevalance in family members and lower education. Level of triglycerides in resistant on antihypertensive treatment patients was significantly higher than in responsive patients. Insulin level in blood in 31 patients with essential hypertension was significantly higher than in 36 healthy persons and 20 patients with renovascular hypertension and resistant on antihypertensive therapy. In 14 patients with essential hypertension resistant to treatment insulin level one hour after oral glucose load was significantly (p < 0.01) higher than in 16 patients with essential hypertension responsive to antihypertensive treatment.

Calcium antagonists (C-A) induce different, renal hemodynamic alterations. They reduce afferent arteriolar resistance and do not change glomerular filtration rate. C-A prevent acute renal failure, especially after kidney transplantation. Calcium antagonists decrease nephrotoxicity of cyclosporine and radiocontrast media. C-A are recommended in the therapy of renovascular hypertension.

The study aimed at evaluating an excretion of beta 2-microglobulin with the urine of hypertensive patients. Thirty patients with mild-to-moderate hypertension (diastolic blood pressure 14.26 +/- 0.86 kPa) and 13 patients with severe hypertension (diastolic blood pressure 17.8 +/- 1.7 kPa) were included into the studies. Significantly increased beta 2-microglobulin excretion with the urine was noted in both groups with the highest values in patients with severe blood hypertension. Moreover, significant correlation between tubular reabsorption of beta 2-microglobulin and diastolic blood pressure was noted in both groups. Increased excretion of beta 2-microglobulin in the arterial hypertension may be due to an increased glomerular filtration of this protein and/or decreased reabsorption in proximal tubule.

The study aimed at evaluating an incidence of hypo- and hypernatremia in the elderly and the results of therapy. Hyponatremia. The studies involved 18 patients aged 69.8 +/- 5.9 years with hyponatremia of 126.8 +/- 2.7 mmol/L. The main causes of hyponatremia were: diuretics, diarrhoea, and vomiting. Sodium deficit was calculated prior to the treatment in all patients. An analysis of hyponatremia incidence indicates that hyponatremia was diagnosed in 1.39% of patients over 60 years, hospitalized within 1989-1990. Sodium deficit in this group was 495.5 +/- 167.7 mmol. Sodium chloride solution was given intravenously to 12 patients, according to the "free correction" principle (a mean increase in serum sodium level was 0.17 +/- 0.07 mmol/L per hour). Mortality in such treated patients was 33%. Sodium chloride was not given to 6 out of examined patients. In 12 patients (66.6%) hyponatremia developed prior to hospitalization, in 6 patients (33.3%) during hospitalization. Mortality rate was 16.6% and 50%, respectively. This confirms higher mortality rate of the rapidly developing hyponatremia in the hospitalized elderly patients. In some cases hyponatremia may constitute iatrogenic complication, especially in the elderly given diuretics in an uncontrollable way. Own experience suggests that elderly patients with a risk of hyponatremia require close monitoring and early compensation of the electrolyte disorders. Hypernatremia. The studies involved 20 patients aged 71.4 +/- 7.7 years with hypernatremia of 155.6 +/- 8.4 mmol/L. A total water deficit (DH20) was calculated in this group. An analysis of hypernatremia incidence showed that this state was diagnosed in 1.55% of patients treated at the Department of Arterial Blood Hypertension within 1989-1990. Total water deficit was 3.9 +/- 1.9 L. A 5% glucose was given intravenously to 15 patients whereas oral fluid therapy was carried out in 5 patients. A mean corrected DH2O in the first day was 46.0 +/- 21.0%. Mortality rate in this group was 65%. It is worth mentioning that 37% of patients with chronic hypernatremia which developed prior to hospitalization died while in case of the acute hypernatremia developed in the hospital mortality rate was 83%. A significant effect on the results of therapy plays an early correction of hypernatremia. Mortality rate in case of DH2o supplementation below 30% during the first 24 hours is about 66%., if DH2o supplementation is 31-60%, a mortality rate is 63%, and in DH2o supplementation over 60% mortality rate is 100%. The obtained results suggest that hypernatremia in the elderly is related to the high mortality rate (65%). An early decrease of water deficit increases mortality rate in patients with hypernatremia.

The effect of a single 20 mg sublingual dose of nifedipine on function of proximal tubule of nephron in patients with essential hypertension was studied by measuring changes in renal excretion of water, sodium, uric acid and beta-2-microglobulin (B2m) after nifedipine administration. Fifteen patients at the mean age of 40.1 +/- 7 years, with mild to moderate essential hypertension were studied. Systolic (SBP) and diastolic (DBP) blood pressure as well as heart rate (HR) were recorded every hour. Urine was sampled over 60-min, four times. The first two periods were regarded controls and the last two periods followed the administration of a 20 mg sublingual nifedipine dose. Blood samples were taken 1 h before and 1 h after that. Sodium, uric acid, B2m and creatinine in urine and plasma were determined. Nifedipine caused a significant fall in SBP and DBP (p < 0.001) and a marked increase in HR (p < 0.001). Diuresis, sodium (CNa) and uric acid (Cua) clearances were significantly increased (p < 0.001). Similarly, fractional excretion of sodium (FENa) was higher (p < 0.01). B2m excretion (UB2m) showed a two fold increase after nifedipine administration (p < 0.01). A positive correlations were found between the changes in CNa and Cua (r = 0.835, p < 0.001) and between the changes in UB2m and CNa (r = 0.747, p < 0.001). The results indicate that nifedipine induces an increase in diuresis, natriuresis and excretion of uric acid and B2m. These findings and the relationship between the changes in UB2m and Cua proves effect of nifedipine on proximal tubular function.

Renal excretion of uric acid was studied in 48 patients with recurrent calcium nephrolithiasis. Hyperuricosuria was found in 16 patients (33%) and among them 10 patients had increased values of urate clearance and fractional excretion. The tubular transport of urate was evaluated by means of pharmacological tests with pyrazinamide (PZA) and benzbromarone (BB) in these 11 patients with hyperuricosuria of renal origin. PZA suppression test was normal in 10 patients while in one case uric acid excretion was not suppressed sufficiently by PZA. Maximal uricorusirc response to BB was increased in two patients, normal in one patient and impaired in eight patients. PZA and BB tests revealed isolated defect of uric acid postsecretory reabsorption in seven patients, impaired reabsorption at both pre- and postsecretory site in one case and enhanced tubular secretion of uric acid in two patients. This study indicates that different defects of uric acid transport in nephron are the frequent cause of hyperuricosuria in patients with recurrent calcium nephrolithiasis.

The study aimed at evaluating the proximal tubule function in patients with active metabolic urolithiasis with the assay of beta 2-microglobulin in the urine. The studies involved 30 patients with urolithiasis associated with chronic pyelonephritis and 31 patients with urolithiasis without pyelonephritis. Fifty healthy individuals served as a control group. Serum and urine beta 2-microglobulin concentrations were assayed with radioimmunological technique in all persons. Clearance of this microglobulin and tubular reabsorption were calculated. It was found that beta 2-microglobulin excretion with the urine is significantly higher in patients with metabolically active urolithiasis accompanied by the chronic pyelonephritis. beta 2-microglobulin clearance was significantly higher and tubular reabsorption significantly lower than those in patients without pyelonephritis and in control group. These finding suggest a dysfunction of the proximal tubule in patients with urolithiasis produced by the chronic inflammatory process in the urinary system. Negative correlation between blood serum beta 2-microglobulin levels and creatinine clearance was shown. Therefore, serum beta 2-microglobulin concentrations may be of value in evaluation of the glomerular filtration rate.

The study aimed at evaluating proximal renal tubule function in patients with nephrolithiasis and chronic pyelonephritis, and in patients with infectious diseases treated with gentamicin. The study involved 2 groups of patients: group A--17 patients with nephrolithiasis and chronic pyelonephritis and group B--30 patients with other infectious diseases (pneumonia, biliary tract infections) but with normal glomerular filtration rate. Patients from both groups were treated with gentamicin in a daily dose of 2-3 mg/kg for 7-10 days. Serum and urine creatinine levels were assayed in all patients prior to, 2-3, 7, 10 days, and after the treatment. Patients assigned to group B were divided into two subgroups: B1 included 15 patients with normal beta 2-microglobulinuria, and B2 15 patients with increased renal loss of beta 2-microglobulin and decreased tubular reabsorption of this protein. Significant increase in beta 2-microglobulinuria was seen on the third day of therapy, the decrease in the tubular reabsorption and glomerular filtration rate were noted in all patients on the seventh day of gentamicin administration. Beta 2-microglobulinuria was significantly higher in patients from groups A and B2 in comparison with group B1 in which no dysfunction of the proximal renal tubule was present before gentamicin therapy. A degree of beta 2-microglobulinuria is an early and sensitive indicator of gentamicin nephrotoxicity. The risk of nephrotixic symptoms is particularly obvious in patients with deteriorated function of renal proximal tubuli before the treatment with gentamicin.

The purpose of the study was assessment of gentamicin nephrotoxicity with reference to proximal tubule function and glomerular filtration. The study was carried out in 20 patients with nephrolithiasis and chronic pyelonephritis, and 33 patients with respiratory and bile tract infections treated with gentamicin in doses of 2-3 mg/kg/2 h. In 3 patients with nephrolithiasis and chronic pyelonephritis signs of increased nephrotoxicity of gentamicin (according to Schentag criteria) were found. Similar signs were demonstrated in 3 patients with non-urinary tract infections. The abnormalities included increased excretion of low-molecular protein and beta-2-microglobulin (B2m), reduction of B2m reabsorption and lower glomerular filtration. Beta-2-microglobulinuria increase precede by 4-5 days the fall of the glomerular filtration rate which suggests that beta-2-microglobulinuria assessment is an early sign of gentamicin neurotoxicity.

The study aimed at presenting own experience in prevention of new urinary calculi in 18 patients with metabolically active calcium urolithiasis treated with hydrochlorothiazide in daily doses of 100 mg (group I) for 2 years, and in 6 patients with the same disease treated with magnesium oxide in daily doses 300 mg twice a day (group II) for average period of 10 months. In 9 patients a new calculus was formed during the treatment with hydrochlorothiazide, in 7 patients no recurrence was noted, and in 2 remaining patients the results were controversial (coral calculus). Therefore, patients were subdivided into group Ia (failure of hydrochlorothiazide therapy), and group Ib (no recurrence noted). Hydrochlorothiazide did not lead to the stable decrease in the saturation of the urine with calcium oxalate in group Ia whereas in group Ib (without recurrence of urolithiasis) the content of calcium oxalate in the urine was significantly lower than that in group Ia after a 2-year treatment with hydrochlorothiazide (p < 0.01) Recurrence of the disease was seen only in one patient of group II, i.e. treated with magnesium oxide. The treatment of the recurrent calcium urolithiasis is justified and efficient in those patients in whom therapy decreases the content of calcium oxalate in the urine.

A case of the malignant mesothelioma of pericardium is presented as this is rare primary neoplasm of pericardium. Diagnosis of the malignant mesothelioma of pericardium is a difficult clinical problem. The authors discuss the value of various diagnostic techniques used in diagnosis of the malignant mesothelioma of pericardium.