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Introduction: Adiponectin demonstrates a protective role against the development of obesity, type 2 diabetes mellitus, and cardiovascular disease. The -11377C 〉 G, -11391G 〉 A, and -11426A 〉 G promoter polymorphisms of ADIPOQ gene influence the level of circulating adiponectin. We examined the level of total and high molecular weight (HMW) adiponectin in centenarians and associated it with biochemical parameters. We checked if the expression and concentration-modifying polymorphisms of ADIPOQ are associated with extreme longevity., Material and Methods: Total and HMW adiponectin were examined using ELISA in 40 female centenarians. The frequencies of the ADIPOQ polymorphisms were tested by restriction fragment length polymorphism in 148 centenarians, 414 young controls, in 207 myocardial infarction patients, and in 190 type 2 diabetes mellitus patients., Results: The mean concentration of total adiponectin in centenarians was 13.19 ± 1.37 mg/mL and of HMW adiponectin it was 9.17 ± 1.15 mg/mL. They were positively correlated with HDL (r = 0.4696, p = 0.0025 and r = 0.3912, p = 0.015, respectively), and negatively with BMI (r = -0.3702, p = 0.034 and r = -0.3963, p = 0.025) and triglycerides (r = -0.346, p = 0.028 and r = -0.3227, p = 0.045). A very rare AA genotype of the -11391G 〉 A polymorphism was significantly more common in centenarians than in young controls (p = 0.026) and, while compared to the GG genotype, it was associated with a 2.4-fold higher mean concentration of total adiponectin (26.53 ± 13.29 mg/ mL v. 10.97 ± 4.28 mg/mL) and with an almost 3-fold higher mean HMW adiponectin (20.65 ± 12.72 mg/mL v. 7.36 ± 3.35 mg/mL)., Conclusions: Serum adiponectin concentration in female centenarians is associated with biochemical parameters that are favourable for cardiovascular risk. We suggest that adiponectin might be of importance for extreme longevity.

Background: Periodontal disease is an inflammatory process which results in increased cardiovascular risk in patients with type 2 diabetes mellitus (DM2). It is not clear, however, whether periodontal inflammation may be associated with increased markers of atherosclerosis in these patients., Aim: This cross-sectional study aimed to answer the question of whether periodontal disease in DM2 is associated with increased markers and risk factors of atherosclerosis., Methods: One hundred and twenty one patients were included in the study. Sixteen were classified as periodontally healthy (BGI-H), 87 as having gingivitis (BGI-G), and 18 as having periodontitis with moderate bleeding (BGI-P2), according to the new Offenbacher classification. In all patients, intima-media thickness (IMT), pulse wave velocity (PWV), lipids, and C-reactive protein (CRP) were assessed., Results: Patients with periodontitis and gingivitis had a higher IMT value compared to the BGI-H group (0.804 ± 0.112 and 0.772 ± 0.127 vs 0.691 ± 0.151 mm, p < 0.01 and p < 0.05, respectively, odds ratio 5.25 for having IMT ≥ 0.8 mm, 95% CI 1.1; 25). Patients from the BGI-P2 group also had higher blood pressure (BP) compared to the BGI-G and BGI-H groups, and higher CRP compared to the BGI-G group (4.6 ± 2.3 vs 3.8 ± 4.8 mg/L, p < 0.01). Lipid parameters and PWV were comparable in all the groups., Conclusions: Periodontal inflammation in patients with DM2 seems to be associated with increased IMT and BP, but not with greater arterial stiffness. These results support the hypothesis that periodontal disease may be associated with a vascular pathology.

The incidences of osteoporosis and chronic kidney disease (CKD) both increase with increasing age, yet there is a paucity of data on treatments for osteoporosis in the setting of impaired kidney function. We examined the efficacy and safety of denosumab (DMAb) among subjects participating in the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) Study. We estimated creatinine clearance (eGFR) using Cockcroft-Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. We examined incident fracture rates; changes in bone mineral density (BMD), serum calcium, and creatinine; and the incidence of adverse events after 36 months of follow-up in subjects receiving DMAb or placebo, stratified by level of kidney function. We used a subgroup interaction term to determine if there were differences in treatment effect by eGFR. Most (93%) women were white, and the mean age was 72.3 ± 5.2 years; 73 women had an eGFR of 15 to 29 mL/min; 2817, between 30 to 59 mL/min; 4069, between 60 to 89 mL/min, and 842 had an eGFR of 90 mL/min or greater. None had stage 5 CKD. Fracture risk reduction and changes in BMD at all sites were in favor of DMAb. The test for treatment by subgroup interaction was not statistically significant, indicating that treatment efficacy did not differ by kidney function. Changes in creatinine and calcium and the incidence of adverse events were similar between groups and did not differ by level of kidney function. It is concluded that DMAb is effective at reducing fracture risk and is not associated with an increase in adverse events among patients with impaired kidney function., (Copyright © 2011 American Society for Bone and Mineral Research.)

Background: Low plasma adiponectin concentration is associated with more frequent occurrence of left ventricular hypertrophy (LVH) and more exaggerated intima-media thickness of common carotid artery (IMT). IMT is an early surrogate marker of atherosclerosis. This study aimed to assess the relationship between plasma adiponectin concentration and left ventricular mass index (LVMI) and IMT in kidney transplant patients (KTP)., Methods: In 88 adult KTP, plasma adiponectin concentration, LVMI, and IMT were estimated. LVH was defined as LVMI >110 or >125 g/m(2) for females and males, respectively. Data presented are means and 95% CI., Results: Plasma adiponectin concentration was similar in KTP with (n = 42) or without LVH (n = 46) (13.5 [11.4-15.6] vs. 13.1 [11.6-14.6] μg/mL, respectively), as well as in KTP subgroups divided according to the IMT value tertiles (p = 0.42) (11.7 [10.0-13.3], 14.2 [11.7-16.6], and 14.0 [11.7-16.4] μg/mL in the lowest, middle, and highest tertiles, respectively). Plasma glucose concentrations were similar in KTPs with LVH or without LVH. No significant correlation was found between plasma adiponectin concentration and both LVMI (R = -0.02; p = 0.87) and IMT (R = 0.09; p = 0.38), respectively., Conclusion: Results of this cross-sectional study do not confirm the roles of low adiponectin and high glucose in the pathogenesis of LVH and atherosclerosis in KTP., (© 2010 John Wiley & Sons A/S.)

Denosumab is the international name of a human, monoclonal antibody approved for the treatment of osteoporosis. This antibody is associated with RANK ligand (RANKL), inactivating it. In consequence, the formation and survival of osteoclasts are suppressed, leading to their apoptosis. All this results in lower bone resorption, while bone mineral density (BMD) increases. Denosumab also reduces the risk of vertebral and non-vertebral fractures. This agent is similarly effective in various stages of renal function impairment; it does not impair fracture healing processes nor contribute to atherosclerosis progression in patients with high cardiovascular risks. Following an analysis of adverse effects, performed in the FREEDOM study (in which it was demonstrated that the incidence of the majority of adverse effects observed in the course of denosumab use was similar to that in the placebo group), its safety for patients can definitely be confirmed.

Introduction: In clinical ambulatory practice, patients often, rather than discontinuing treatment, change to another one. This study aims to assess the reasons why patients with osteoporosis switch from one alendronate to another with a different brand name., Material and Methods: A retrospective analysis of 747 bisphosphonate-treated patients was performed (651 female, average age 67.3 ± 8.9 years, BMI 26.5 ± 4.0 kg/m(2)). The frequency and reasons for drug switching during the 19.4 ± 13.4 months of observation were analysed., Results: In 387 (51.8%) patients, treatment was not changed during the observation period, whereas in 360 (48.2%) patients, at least one drug switch occurred. Almost 40% of patients from that group (138 patients) switched from one alendronate to another alendronate with a different brand name. The most frequent reasons were: adverse event (36.9%), high price of the drug (23.2%) and request of patient (16.7%)., Conclusions: A substantial proportion of persistent bisphosphonate-treated patients switch treatment from one alendronate to another. The most frequent reasons for that kind of switching are the occurrence of an adverse event and the high cost of treatment.

Introduction: This study aimed to answer the question of whether chronic periodontitis in subjects with type 2 diabetes mellitus is associated with increased left ventricular mass (LVM) and systemic and central blood pressure (CBP)., Material and Methods: One hundred and fifty-five subjects with type 2 diabetes (67 F, 88 M, mean age 61.1±6.9 years, BMI 32.7±5.7 kg/m(2)) were divided according to their periodontal status into biofilm-gingival interface - healthy (BGI-H, 14 subjects), BGI-gingivitis (BGI-G, 119 subjects) and BGI-periodontitis (BGI-P, 22 subjects) groups. In all subjects, LVM, systemic and CBP were measured. The LVM index (LVMI) was calculated., Results: (1) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM (238.6 g; 206.6-267.4 and 222.8 g; 207.0-238.2) versus BGI-H subjects (170.3 g; 125.5-217.8).
(2) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM1 (95.2 g/m(2) ; 82.9-107.4) and 87.8 g/m(2) ; 81.5-94.1) versus BGI-H subjects (63.7 g/m(2) ; 45.2-62.3).
(3) BGI-P subjects had higher central and systemic systolic and diastolic blood pressure than subjects from BGI-G and BGI-H groups., Conclusion: In subjects with type 2 diabetes, periodontitis and gingivitis are associated with increased LVM and periodontitis is associated with increased central and systemic blood pressure., (© 2010 John Wiley & Sons A/S.)

Immunoablation with autologous hematopoietic cell transplantation has shown some effectiveness in the treatment of autoimmune diseases as diverse as aplastic anemia, systemic lupus erythematosus, multiple sclerosis and Crohn's disease. It has been recently shown that this treatment might prevent or delay development of diabetes type 1. The majority of more than 30 patients with early diabetes type 1 who underwent immunoablation and hematopoietic cell transplantation in various centers in the world achieved durable remission of diabetes and independence of exogenous insulin. This review summarizes advantages and risks of this treatment of early diabetes type 1.

Introduction: Clinical studies have shown either positive or in some other cases negative correlations between leptinemia and bone mineral density (BMD) or bone mineral content (BMC)., Objectives: The aim of the present study was to assess whether these discrepancies might be associated with the effect of G(-2548)A leptin or A326G and A668G leptin receptor gene polymorphisms on serum leptin concentrations or BMD and BMC., Patients and Methods: The study included 72 obese patients (39 women and 33 men, aged 46 +/-8.8 years; body mass index [BMI] >30 kg/m2). In all subjects, serum creatinine, glucose, lipids, leptin, and insulin were determined. Total fat mass (TFM), BMC, and BMD were assessed using dual energy X-ray absorptiometry (Lunar DPX-L)., Results: No significant correlations were observed between body mass composition parameters (TFM, lean mass, BMC) or BMD in relation to genotypes. A positive correlation was found between serum leptin concentration and BMI. An inverse association was observed between leptin concentrations and BMC. Multiple regression analysis showed independent correlations of leptinemia with sex (P <0.001), TFM (P <0.000 001), BMC (P = 0.0001), and the presence of (-2548)A allele of the leptin gene (P <0.05). These parameters together accounted for 83% of variability in serum leptin concentrations., Conclusions: In obese patients, serum leptin concentration shows an independent inverse correlation with BMD and male sex, but positively with TFM and the presence of -2548A allele of leptin gene. These parameters are responsible for 83% of leptin concentration variability. No correlations between the examined polymorphisms and BMC or BMD were found.

Introduction: Vegetarian diets can be healthy when they are well balanced and if a variety of foods is consumed. However, elimination of animal products from the diet (vegan diets) decreases the intake of some essential nutrients and may influence the bone metabolism. This is especially important in childhood and adolescence, when growth and bone turnover are most intensive. The aim of the study was to assess the effect of vegan diet on bone density (BMD) density and serum concentrations of bone metabolism markers., Material and Methods: We examined a family on vegan diet which consisted of parents and two children. Dietary constituents were analysed using a nutritional program. Total and regional BMD were measured by dual-energy X-ray absorptiometry. Concentrations of calcium and phosphate in serum obtained from fasting patients were determined by colorimetric methods, 25-hydroxyvitamin D by the chemiluminescence method and bone turnover markers by specific enzyme immunoassays., Results: In studied vegans, the dietary intake of phosphate was adequate while calcium and vitamin D were below the recommended range. Concentrations of calcium, phosphate and bone turnover markers in the serum of all subjects were within the physiological range, but 25-hydroxyvitamin D level was low. Age-matched Z-score total BMD was between -0.6 and 0.3 in adults, however in children it was lower (-0.9 and -1.0). Z-score BMD lumbar spine (L2-L4) was between -0.9 to -1.9 in parents and -1.5 to -1.7 in children., Conclusions: Our results suggest that an inadequate dietary intake of calcium and vitamin D may impair the bone turnover rate and cause a decrease in bone mineral density in vegans. The parameters of bone density and bone metabolism should be monitored in vegans, especially children, in order to prevent bone abnormalities.

Introduction: Bone and mineral metabolism is influenced by thyroid hormones, and levothyroxine (LT(4)) therapy may be associated with reduced bone mass in postmenopausal women., Material and Methods: The aim of the study was to assess the influence of one year of LT(4) treatment in a group of 21 adolescent girls with euthyroid diffuse goiter. Lumbar (L(2)-L(4)) and total body bone mineral density (TOBMD) (Lunar - DXA), serum PTH, osteocalcin, bone alkaline phosphate, vitamin D(3), calcium, and phosphorus levels and urinary excretion of Ca, P, and hydroxyproline were measured before and after one year of combined LT(4) and iodine treatment., Results: Patients were matched for age, sex, BMI, and maturation status, with controls treated with iodine only. Markers of bone turnover changed in a similar manner in both groups. There was no significant difference in TOBMD value after one year of therapy between LT(4) treated group and controls. Densitometric lumbar spine parameters increased significantly after 12 months in both groups, with no significant differences between them., Conclusion: It can be concluded that one year of LT(4) treatment of adolescent girls with euthyroid diffuse goiter does not have a negative impact on their bone remodelling and metabolism. (Pol J Endocrinol 2010; 61 (1): 14-19).

This paper reviews the structure, function, and pathophysiology of glucagon-like peptide 1 (GLP-1). It describes the physiology and pathophysiology of the incretin axis, of which GLP-1 is a component, as well as the biosynthesis, secretion, activity, and degradation of this intestinal hormone. Effects of GLP-1 on the endocrine function of the pancreas, cardiovascular system, central nervous system, and on water-electrolyte balance have been also presented.

Introduction: So far only scarce data have been published regarding serum vitamin D concentrations in elderly women in Poland., Objectives: We aimed to assess prevalence of vitamin D deficiency in a population of women aged 60 to 90 years and living in Warsaw., Patients and Methods: The study comprised 274 women from the general population (mean age 69.1 -/+5.7 years, body mass index [BMI] 28.9 -/+4.6 kg/m2, serum creatinine concentration 0.7 -/+0.12 mg/dl). Subjects who had been treated with glucocorticoids or antifracture drugs, or supplemented with vitamin D or calcium, were excluded. The study was conducted in winter. Serum vitamin D, calcium, phosphate, and parathyroid hormone (PTH) concentrations were measured., Results: The mean vitamin D concentration was 13.6 ng/ml in the whole examined population. Vitamin D levels above 30 ng/ml were detected in 4% of subjects. Vitamin D insufficiency (20-30 ng/ml) was found in 12.8% of subjects, and its deficiency (<20 ng/ml) in 83.2% of subjects. Vitamin D concentrations in women under and over 70 years of age did not differ significantly. There were no associations of vitamin D concentrations with age, BMI, renal function, or serum calcium concentrations. However, we observed a significant inverse correlation between vitamin D concentrations and PTH., Conclusions: The prevalence of low vitamin D concentrations in an urban population of elderly women in Poland is very high. Lower vitamin D levels are associated with a higher PTH concentration.

An essential component of type 1 diabetes mellitus is autoaggression of the immune system against insulin-secreting pancreatic cells. It is thought that early destruction of the autoaggressive mechanism prior to the complete damage of beta cells should halt this process. In a 28-year-old male patient with a 4-week history of type 1 diabetes mellitus, three courses of plasmapheresis had been performed before cyclophosphamide, 2 g/m2 body surface area, was administered and hematopoietic cells were obtained. Six weeks after the diagnosis, 4 doses of cyclophosphamide 50 mg/kg body weight were again administered together with antithymocyte globulin, and autologous hematopoietic cells were transplanted. The procedure was associated with no significant side effects. Insulin requirement started to drop from the first course of plasmapheresis, and the patient has remained normoglycemic with no need of exogenous insulin or other hypoglycemic agents since the third week after the procedure, which has been 5 months until publication of this report. Independence from exogenous insulin is associated with the implemented therapy (a gradual decrease in insulin requirement has been observed after consecutive stages of the immunosuppressive treatment, with total discontinuation after bone marrow transplantation). The course of the disease and the type of treatment may suggest that such medical procedures could eliminate autoaggressive mechanism in diabetes and prevent further degeneration of insulin-producing cells, thus becoming a new therapeutic option for patients with type 1 diabetes mellitus.

The presented paper aims to summarize knowledge regarding senile osteoporosis. The article highlights high prevalence of the disease and the burden caused by osteoporotic fractures on the healthcare system. It describes shortly a complex ethiopathogenesis, in which vitamin D deficiency, other hormonal disturbances, protein-energy malnutrition, dysfunction of neuromuscular system and other factors may play a role. Possible diagnostics (x-rays, dual x-ray absorptiometry, 10-years fracture risk) and therapeutic methods are also presented.

Introduction: Recently, a new fracture risk-assessment calculator (FRAX) has been introduced. The aim of this study was to assess its usefulness for the re-assessment of fracture risk in obese patients and re-assignment to treatment., Material and Methods: 350 obese female patients were included. In all of them, 10-year fracture risk was calculated using FRAX (with and without T score value)., Results: If major osteoporotic fracture risk was calculated with BMD, it was low in most of the patients (in 82.1% of those treated, and in 95.9% of those not treated it was below 10%). Mean risk values were significantly higher in the treated (7.7 [3;39]%) than in the non-treated group (4.6 [2.1;14]%). The reason for start of treatment in 95 out of 106 patients was a sustained low-energy fracture, low BMD, or both., Conclusions: The WHO fracture risk calculator may be a useful tool in treated obese females with osteoporosis. The information regarding 10-year fracture risk may change the treatment strategy at least for those in whom the decision of treatment was based solely on low BMD.

Objective: The aim of the study is to analyze whether chronic periodontitis (CP) influences serum tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and high-sensitivity C-reactive protein (hs-CRP) concentrations in renal transplant recipients and patients or graft survival., Background: CP is associated both with higher serum concentrations of cytokines and CRP and high cardiovascular risk., Methods: One hundred and seventeen patients with a transplanted kidney (Tx) were divided according to the Community Periodontal Index of Treatment Needs (CPITN) into two subgroups: TxP+: severe CP (CPITN 3-4) and TxP-: no or moderate CP (CPITN 0-2). The control group (C) consisted of 36 subjects with no kidney disease and with no or moderate CP (CPITN 0-2)., Results: hs-CRP concentration was higher in TxP+ than in TxP- patients [2.0 mg/L (0.7-4.4) vs. 0.9 mg/L (0.3-1.9), p = 0.006]. There were no differences in serum TNF-alpha and IL-6 between TxP+ and TxP-. Significant positive correlation between CPITN score and hs-CRP concentration was found both in Tx and C. The hazard ratio of death was 7.17 (1.4-76.4) for TxP+ patients. CP status did not increase the risk of graft loss or doubling of serum creatinine., Conclusions: Severe CP is associated with increased serum hs-CRP concentration in patients after kidney transplantation. Severe periodontitis seems to increase the risk of patients' death after kidney transplantation.

Introduction: Simultaneous pancreas-kidney transplantation (SPK) is associated with high risk of infectious complications., Objectives: The aim of the study was to evaluate the incidence of bacterial infections within 3 months after SPK transplantation., Patients and Methods: 17 patients with type 1 diabetes at the age of 32-54 years (mean age 42.5 +/- 7.1) were retrospectively analyzed within 3 months after SPK., Results: No septic complications were observed in 2 patients (12%). In the remaining 15 patients (88%), at least 1 (from 1 to 5, a total of 30) infection episode was observed during follow-up. The infections were located: only at the surgical site (1 patient--6.7%), only in the urinary tract (6 patients--40%), both at the surgical site and in the urinary tract (7 patients--46.7%), at the surgical site and in blood (1 patient--6.7%). 2 groups of microbes were predominant, namely enterococci represented by 1 species, E. faecium (13 isolates) and the so-called intestinal bacilli, Enterobacteriaceae (19 isolates). No methicillin resistant Staphylococcus aureus strains were isolated. Candida species fungi were isolated only 3 times., Conclusions: In our study only 2 types of infections were observed (urinary tract and surgical site infections) and each of them comprised nearly half of all the septic episodes recorded. Gram-negative bacilli were collected more often than Gram-positive cocci, both from the surgical site and urinary tract infections. All infections ended with full recovery.

Introduction: Ageing may cause an increase in parathormone (PTH) secretion and, subsequently, increased bone resorption and osteoporosis. In recent years two subfractions of PTH have been discovered: cyclase-activating (1-84, CAP) and cyclase-inhibiting (7-84, CIP) PTH. It is not known however, whether these may play a role in the pathogenesis of bone loss in elderly subjects., Material and Methods: Sixty elderly women were examined, of whom 29 had a T-score of the ultradistal radius < -2.5 (median age 75 [70-80] years, BMI 25 [20.6-33.8] kg/m(2), creatinine clearance 59.9 [39.2-94.9] ml/min/1.73m(2), serum Ca 2.4 [2.2-2.6] mmol/l), while 31 had a T-score > -2.5 (median age 73 [70-86] years, BMI 26.2 [18.8-32.5] kg/m(2), creatinine clearance 54.8 [23-119.2] ml/min/1.73m(2), serum Ca 2.4 [2.2-2.6] mmol/l). Median bone mineral density (BMD) (DXA, Lunar) of the ultradistal radius was 0.263 (0.195-0.449) g/cm(2) and 0.326 (0.236-0.448) g/cm(2) (p < 0.0001), with a median T-score of -3.48 and -1.4, respectively. Each patient with a serum concentration of 1-84 and 7-84 PTH was assessed., Results: Patients with low BMD did not differ from those with higher BMD with regard to serum iPTH (16 [6-51] vs. 11.5 [7-35] pg/ml, p = 0.066) and CIP (6 [1-14] vs. 4.5 [2-13] pg/ml) concentrations. However, serum CAP concentrations (10.5 [4-41] vs. 6 [4-22] pg/ml, p < 0.05) and CAP/CIP ratios (2.0 [0.71-11] vs. 1.25 [0.5-4.2], p < 0.05) were significantly higher in the low BMD group., Conclusion: In elderly women increased serum CAP concentrations and CAP/CIP ratios are associated with low BMD of the trabecular bone.

Still's disease is a systemic manifestation of juvenile arthritis that rarely occurs in adults and therefore is often forgotten in differential diagnosis of fever of unknown origin. The case presented here shows diagnostic difficulties in a patient with silicone breast implants and fever with Still disease. The cause-effect relationship between breast implants and Still disease is not certain, however, this possibility should be considered when a patient with fever resistant to antibiotics and with silicone implants is admitted to the hospital.

Background: An increasing number of papers have documented the contribution of chronic periodontitis (P) to the pathogenesis of cardiovascular disease. The aim of this study was to answer the question whether there is an association between periodontal inflammation and atherosclerotic processes in hemodialysis patients with chronic kidney disease (CKD)., Methods: Forty-four hemodialysis patients with CKD were considered. Advanced chronic periodontitis was found in 17, whereas 27 patients had no or moderate chronic periodontitis. In all patients examined, serum C-reactive protein (CRP), TNF-alfa and IL-6 concentrations, as well as intima-media thickness (IMT) of the carotid artery, were assessed., Results: Patients with CKD and advanced periodontitis were characterized by a significantly higher serum CRP concentration (13.2 +/- 11.4 vs. 10.4 +/- 14.4; p<0.05) and IMT (0.742 +/- 0.028 vs. 0.656 +/- 0.019, p<0.05) than CKD patients without periodontitis. In the univariate analysis, a significant correlation between CRP and number of atherosclerotic plaques was revealed; however, it was not confirmed as an independent relationship in the multiple regression analysis., Conclusions: Inflammation of the periodontal tissue in patients with CKD is associated with increased serum CRP concentration and greater IMT. It is possible that periodontitis may induce a systemic process that may exacerbate atherosclerosis.

Unlabelled: The present study aimed to assess the oral hygiene in haemodialyzed patients with chronic renal failure (CRF)., Material and Methods: 44 haemodialyzed patients with CRF were analyzed (18 F and 26 M, mean age 47.4 +/- 1.6). In all patients a stomatological examination and dental panoramic x-ray were performed. The presence of chronic periodontal disease (CP) and an approximal plaque index (API) were assessed., Results: Chronic periodontitis was found in 17 patients (39%), whereas in 27 (61%) patients periodontal disease was not present. Oral hygiene assessed by API was not satisfactory in 50%, while very good only in 11% haemodialyzed patients. Patients with periodontal disease were characterized by worse API than patients without periodontitis., Conclusion: Oral hygiene status is unsatisfactory in most of haemodialyzed uremic patients.

Periodontal disease (PD) may cause a systemic inflammatory reaction and contribute to left ventricular hypertrophy (LVH) in hypertensive subjects. This study aimed to assess whether chronic PD may contribute to LVH in patients after kidney transplantation. The study analyzed 99 patients divided according to Community Periodontal Index of Treatment Needs (CPITN) score into patients with advanced PD (CPITN 3-4) and patients without or with moderate periodontal lesions (CPITN 0-2). Patients with CPITN 3 to 4 were characterized by a significantly higher plasma high-sensitivity C-reactive protein (HS-CRP) concentration (6.2+/-2.2 vs. 1.7+/-0.3 mg/L, P<0.05) and left ventricular mass index (LVMI) (150+/-7 vs. 111+/-3 g/m, P<0.001) in comparison with patients with CPITN 0 to 2. In the multiple regression model, LVMI was dependent on CPITN (P<0.001), HS-CRP (P<0.05), serum cholesterol (P<0.05), and creatinine concentration (P<0.05). In conclusion, it appears that advanced PD in patients after kidney transplantation is associated with LVH.

Unlabelled: Orlistat is an inhibitor of lipase which splits triglycerides into free fatty acides and glycerol. This drug, by inhibiting hydrolysis of triglycerides, is the cause of significant loss of fat in the faeces. 13 obese and 15 nonobese subjects were examined. Obese subjects received orlistat (Xenical, F. Hoffmann La Roche Ltd, Switzerland) 3 x 120 mg/d. Treatment with orlistat for 16 weeks was followed by a significant fall of BMI and MAP, insulinemia, insulin/glucose ratio, leptinemia, serum total cholesterol, triglycerides, HDL-cholesterol and 25-OH-D concentration respectively. Orlistat did not influence significantly serum LDL-cholesterol concentration but unexpectedly increased plasma levels of folic acid, vitamin B12 and NPY., Conclusions: (1) Monitoring of plasma 25-OH-D levels in obese patients on orlistat therapy seems to be mandatory. (2) In spite of significant changes (in opposite direction) in leptinemia and serum NPY level observed in obese subjects treated with orlistat, presence of a functional relationship between these hormones could not be confirmed.

In patients with cancers progressive reduction of body mass is frequently recent. Pathogenesis of cachexia in patients with cancer is multifactorial. Such factors as cytokines, peptides relieved by tumor mass and different forms of treatment as radio or chemotherapy may play a major role in the pathogenesis of cachexia in patients with cancer. The aim of this study was to assess the relationship between body fat and lean mass and plasma leptin, NPY and TNF concentrations in patients with cancer of oral cavity and pharynx, cancer of larynx and non-Hodgkin lymphoma (NIL). 30 patients (10 with cancer of oral cavity and pharynx, 10 with cancer of larynx and 10 with non-Hodgkin lymphoma) were enrolled into this study. Mean age of all cancer patients was 50 +/- 2.9 years (from 18 to 76 years). The control group consisted of 29 healthy subjects with a means age 48 +/- 3.5 years (from 18 to 75 years), properly chosen according to the body weight, BMI, gender and age as above mentioned groups of patients with cancer. In control and study groups body fat and not-fat mass was assessed before and after treatment using the bioelectrical impedance method. Before oncological therapy patients with cancer did not differ from healthy subject with regard to body weight and body mass index. After treatment significant: decrease of body weight, body fat mass and BMI was observed. Serum leptin, NPY and TNF concentrations were analysed in healthy subjects and patients with cancer before and after treatment. Before oncological treatment significantly lower serum leptin concentration in comparison to leptinaemia in control group was found. In contrast to serum leptin, NPY serum concentration was similar in patients with cancer and in control subjects. Serum concentration of TNF was significantly higher in patients with cancer in comparison to subjects of control group. After oncological treatment, serum leptin and NPY concentration did not change significantly. In contrast, serum TNF concentration decreased significantly after oncological therapy. From the results obtained in this study we can conclude, that in patients with cancer secretion of leptin is decreased in relation to body fat mass. However, contribution of this hormone to pathogenesis of cancer induced anorexia seems not to proven. From the other side, the role of TNF in pathogenesis of disregulation of leptin secretion seems to be very likely. After chemo or radiotherapy, serum NPY concentration did not change significantly. After this oncological treatment the relationship between serum leptin concentration and body mass is no longer significant.

Methodology of soft tissues wounds, ulcers and pressure sores healing with direct current is described by the authors. Results of clinical trials and animal experiments are represented, as well as technical and using data. Electrical properties of damaged tissues (e. i. skin battery, vascular-interstitial closed circuits etc.) and probable electrical healing mechanisms are discussed. Effects of electrical current on batteries are described. Inductive and capacitive coupling of electric and magnetic fields, and high voltage electrostimulation for enhance tissue healing are also described in the article.

The reasons of investigators' interest of damaged tissues healing with electrical current in concise form are represented by the authors. The nonunions and pseudarthroses healing with direct current through negative polarized electrode is described in this article. Hypothetic biological healing mechanisms (as piezoelectric activity, streaming potentials, electric properties of glycosaminoglycan etc.) are discussed. Technical data of currents and their antibacterial properties are described.

Background: In patients with nephrotic syndrome, the natriuretic effect of furosemide (FU) is diminished. The effect of coadministration of FU and human albumin (HA) has remained controversial., Methods: In a double-blind, placebo-controlled study, nine nephrotic patients (six males, 48 +/- 4 years) on standardized sodium chloride intake, in random order on three separate days, received by intravenous administration for 60 minutes either (a) 60 mg FU plus a sham infusion, (b) 60 mg FU plus 200 ml of a 20% solution of HA, or (c) sham infusion plus 200 ml of a 20% solution of HA. Urinary volume, sodium, albumin and FU excretion, renal hemodynamics, and plasma atrial natriuretic factor concentration were assessed., Results: Administration of FU alone significantly (P < 0.01) increased mean cumulative urinary sodium (259 +/- 30 mmol) and volume excretion (2684 +/- 167 ml) in the first eight hours as compared with the HA infusion alone (118 +/- 12 mmol, 1827 +/- 141 ml). The coadministration of FU and HA caused an even more marked increase (P < 0.01 vs. HA alone) of urinary sodium (312 +/- 28 mmol) and volume excretion (3230 +/- 201 ml); the difference to FU administration alone was significant (P < 0.05). Plasma atrial natriuretic factor, serum albumin concentration, and urinary albumin excretion increased significantly on both HA infusion days, whereas urinary excretion of FU remained unchanged with HA coadministration. Glomerular filtration rate (CIn) was not significantly affected by any of the infusion protocols, but effective renal plasma flow (CPAH) increased significantly on both HA infusion days., Conclusions: Coadministration of HA potentiates the action of FU in patients with the nephrotic syndrome, but only modestly. This effect is mediated by changes in renal hemodynamics.

In uremic patients resistance to the action of insulin has been documented, but it is not known at what stage of renal disease it appears. We therefore examined 29 patients with IgA glomerulonephritis (IgAGN) and 21 patients with adult polycystic kidney disease (ADPKD) in different stages of renal failure, and in addition, healthy age-matched subjects. Insulin sensitivity and other variables of glucose metabolism were assessed using a frequent sampling intravenous glucose tolerance test (minimal-model technique). Glomerular filtration rate (GFR) was assessed in renal patients using the inulin-clearance technique. Mean insulin sensitivity index (SI), that is, insulin sensitivity, was significantly lower (P < 0.001) in all patients combined than in matched healthy subjects (N = 16; 14 males, mean age 42 +/- 3 years; mean SI 8.6 +/- 0.8 min-1 uU/ml). The mean SI was not significantly different in patients with renal disease of immune (IgAGN) or non-immune (ADPKD) origin, and it was not correlated with GFR (r = 0.01, P < 0.52), intact PTH (r = -0.23, P < 0.11) or calcitriol concentration (r = -0.03, P < 0.82). Consequently, the mean SI was similar in renal patients with GFR within the normal range (N = 19; 17 males, mean age 41 +/- 2 years; mean GFR 119 +/- 5 ml/min/1.73 m2; 5.1 +/- 0.7 min-1 uU/ml), in patients with mild to moderate renal failure (N = 16; 15 males, 46 +/- 3 years; 67 +/- 4 ml/min/1.73 m2; 5.1 +/- 0.7 min-1 microU/ml) and in patients with advanced renal failure (N = 15; 13 males, 46 +/- 3 years; 25 +/- 2 ml/min/1.73 m2; 4.7 +/- 0.6 min-1 uU/ml). Mean fasted plasma insulin concentration, the area under the curve for plasma insulin concentration (AUC) and total insulin delivery (TID) during the glucose tolerance test were significantly higher in patients than in healthy subjects, reflecting hyperinsulinemia in renal patients. Further, fasted plasma insulin concentration (r = -0.32, P < 0.009), AUC (r = -0.62, P < 0.0001) and TID (r = -0.34, P < 0.004) in patients were significantly correlated with insulin sensitivity (SI). The present data document that insulin resistance and concomitant hyperinsulinemia are present early in the course of renal disease, that is, even in patients with GFR within the normal range, irrespective of the type of renal disease. This observation may have potential implications with respect to the high cardiovascular morbidity and mortality in patients with renal disease.

Administration of active vitamin D (calcitriol) improves insulin sensitivity in uraemic patients. These patients have subnormal plasma calcitriol concentrations in parallel with increased intact parathyroid hormone (PTH) concentrations. It is therefore unclear whether the improvement in insulin sensitivity results from a direct effect of calcitriol or from amelioration of secondary hyperparathyroidism. So far, no evidence has been presented that insulin sensitivity is specifically affected by calcitriol in healthy subjects. We investigated the effect of (supra)therapeutic doses of calcitriol on insulin sensitivity in healthy volunteers. In a double-blind parallel group design, 18 healthy male subjects received in random order either placebo or 1.5 micrograms of calcitriol per day by mouth for 7 days. Insulin-mediated glucose uptake, i.e. insulin sensitivity, was assessed using the euglycaemic clamp technique. Mean glucose disposal rate, i.e. M-value, was not significantly affected by placebo or calcitriol treatment (placebo: 7.1 +/- 1.3 mg kg-1 min-1 before and 7.2 +/- 1.5 mg kg-1 min-1 after treatment; calcitriol 7.0 +/- 1.4 mg kg-1 min-1 and 7.2 +/- 1.4 mg kg-1 min-1). There were no significant changes in mean plasma glucose, insulin, phosphate, bicarbonate and ionized calcium concentrations after administration of placebo or calcitriol. Furthermore, platelet intracellular calcium concentration (assessed by fluorescence spectroscopy) and mean arterial blood pressure (24 h ambulatory measurement) did not change with placebo and calcitriol treatment. On the other hand, mean intact PTH concentration decreased significantly (P < 0.01) with calcitriol treatment, but not with placebo. In addition, mean 24 h urinary calcium excretion increased significantly (P < 0.05) with calcitriol administration but was unchanged with placebo. Administration of (supra)physiological doses of calcitriol has no effect on insulin sensitivity in healthy subjects, despite a significant decrease in PTH concentrations. These observations are compatible with the notion that the effect of calcitriol on insulin sensitivity is present only in uraemic calcitriol-depleted patients.

Background: Acute administration of parathyroid hormone (PTH) causes vasodilation and blood pressure decrease in experimental animals. This effect contrasts with the putative role of secondary hyperparathyroidism in the pathogenesis of hypertension of patients with renal failure. Uraemia is characterized by insulin resistance and hyperinsulinaemia. We therefore investigated whether subacute administration of physiological doses of human 1,34-PTH affects blood pressure under conditions of controlled insulin levels (euglycaemic clamp technique) in humans., Methods: In a double-blind cross-over design 10 healthy male subjects received, on two occasions, in random order, for 2 h, either a sham infusion or an infusion of 200 units of 1,34-PTH., Results: Mean ionized calcium concentration increased significantly (P < 0.01) within the normal range during euglycaemic hyperinsulinaemia, both with sham infusion (from 1.25 +/- 0.04 to 1.29 +/- 0.02 mmol/l) and with infusion of 1,34-PTH, but the increase was more marked with 1,34-PTH administration (from 1.26 +/- 0.05 to 1.33 +/- 0.07). In addition, mean platelet intracellular calcium concentration (by fluorescence spectroscopy) was unchanged with sham infusion (49.9 +/- 4.1 versus 50.3 +/- 5.0 nmol), but increased significantly (P < 0.05; paired t-test) after 1,34-PTH infusion (from 49.8 +/- 5.0 to 52.8 +/- 5.8). The infusion of 1,34-PTH resulted in a significant (P < 0.01) increase in mean MAP (from 84 +/- 5 to 88 +/- 5 mmHg) as compared with sham infusion (85 +/- 4 versus 86 +/- 4). The intra-individual changes in intracellular calcium concentration (delta[Ca2+]i) were significantly correlated to the changes in mean MAP (delta MAP) (r = 0.87, P < 0.001). In contrast to blood pressure, insulin sensitivity was not affected by 1,34-PTH infusion (M-value: 7.2 +/- 1.6 mg/kg per min) as compared with sham infusion (7.3 +/- 1.4)., Conclusion: Subacute administration of physiological doses of parathyroid hormone under hyperinsulinaemic conditions significantly affects intracellular calcium and blood pressure in healthy subjects, but does not affect the action of insulin.

In senescence renal function is thought to decline markedly even in the absence of renal disease. It has also been proposed that the changes in renal function with age are not uniform and that confounding factors such as hypertension or atherosclerosis may play a role. We performed a comprehensive study to compare several aspects of renal function in four groups: (i) young healthy normotensive subjects (N = 24; 13 males; mean age 26 +/- 3 years); (ii) elderly healthy normotensive subjects (elderly NT; N = 29; 13 males; 68 +/- 7 years); (iii) elderly treated and untreated hypertensive patients (elderly HT; N = 25; 13 males; 70 +/- 6 years); and (iv) elderly patients with compensated mild to moderate heart failure (elderly HF; N = 14; 6 males; 69 +/- 6 years). Compared to young subjects mean GFR (C(In)) and ERPF (C(PAH)) were significantly lower in the elderly, despite similar mean plasma creatinine levels (young, 121 +/- 11, 650 +/- 85 ml/min/1.73 m2; elderly NT, 103 +/- 11, 486 +/- 102; elderly HT, 103 +/- 13, 427 +/- 55; elderly HF, 92 +/- 14, 377 +/- 103). Nevertheless, GFR was within the normal range in the majority of elderly NT and HT, but not in elderly HF. ERPF was significantly lower in elderly HT as compared with elderly NT, and still lower in elderly HF. Mean renovascular resistance and filtration fraction were significantly higher in the elderly, particularly in elderly HT and HF as compared with the young. Mean fractional excretion of Na+ was similar in all groups studied, but the lithium clearance was significantly lower in the elderly, suggesting a greater proximal and less distal sodium reabsorption in senescence. In the elderly, mean PTH concentration and urinary excretion of pyridoline cross-links were significantly higher and mean 25-(OH)D3, calcitriol and phosphate concentrations significantly lower; the correlation between PTH and GFR was significant (r = -0.432, P < 0.001). The results document that the decrease in renal hemodynamics with senescence is less marked than suggested by some studies using less stringent methodology and inclusion criteria. Comorbid conditions confound renal function in the elderly. Age-associated changes in renal hemodynamics are accompanied by significant alterations of renal hormones and of renal sodium handling.

Objective: Angiotensin II (Ang II) increases insulin sensitivity in healthy volunteers. This effect is thought to be mediated, at least in part, by an increase in skeletal muscle blood flow. In the past it had been documented that some biological actions of Ang II are altered in diabetes. We addressed the issue of whether this is also true for its action on insulin sensitivity., Design and Methods: Twelve healthy volunteers (aged 43+/-9 years) and 15 patients with type 2 diabetes mellitus (NIDDM) of recent onset (aged 45+/-9 years) were allocated in random order in a double-blind placebo-controlled design to be administered a sham infusion or an infusion of 2 ng Ang II/kg per min. Insulin-stimulated glucose uptake (the M value) was measured with the euglycaemic clamp technique, leg muscle blood flow (MBF) with plethysmography, blood pressure with a Dinamap device, and glomerular filtration rate and effective renal plasma flow with the steady-state inulin (Cin) and p-aminohippurate (CPAH) clearance methods, respectively., Results: In volunteers the mean M-value after Ang II infusion (10.1+/-1.5 mg/kg per min) was significantly higher (P < 0.01) than that after sham infusion (8.2+/-0.9 mg/kg per min). In contrast, in diabetic patients it was not significantly different with Ang II (6.1+/-1.3 mg/kg per min) and sham infusion (5.5+/-1.2 mg/kg per min). The difference in the mean absolute increase in the M value (deltaM) between groups was significant (P< 0.02). The Ang II-induced increase in MBF under euglycaemic conditions was attenuated in diabetic patients (from 15.0+/-3.5 to 15.5+/-3.9 ml/100 ml per min, NS) compared with volunteers (from 16.8+/-3.3 to 19.1+/-3.7 ml/100 ml per min, P< 0.01). Again, the difference between the mean absolute increases in MBF (deltaMBF) in the groups was significant (P < 0.01). A significant correlation was found between deltaMBF and deltaM (r= 0.62, P<0.01). The absolute acute increase in mean arterial blood pressure with Ang II was similar in diabetic patients and volunteers. Mean Cin, CPAH and fractional sodium excretion values were significantly lower and renal vascular resistances and filtration fractions higher during the Ang II than they were during the placebo clamp period. This was observed in patients as well as in healthy subjects, but the effects of Ang II on renal haemodynamics and sodium handling were more pronounced in diabetic patients., Conclusions: In patients with NIDDM of recent onset the stimulatory effect of Ang II on insulin sensitivity and on skeletal muscle blood flow is attenuated. In contrast, the effects of Ang II on renal perfusion and sodium handling are more pronounced in patients with NIDDM than they are in healthy subjects.

The present study aimed to assess the influence of acetate (AC) and bicarbonate (BI) hemodialysis with a cuprophane membrane on plasma erythropoietin (EPO) levels in 30 patients with chronic renal failure (CRF). Fifteen patients were severely anemic with an Hct below 30%, while 13 were moderately anemic with an Hct equal to or more than 30%. None had received rHuEPO or ACE inhibitors before the study. Blood samples for EPO and pO2 estimation were withdrawn before and after 1, 2 and 5 h of AC dialysis. In 11 of the patients with an Hct < 30% the same protocol was repeated during BI dialysis. In spite of a significant decrease in pO2 during the first hour of AC dialysis, the plasma EPO concentration decreased significantly in both severely and moderately anemic CRF patients from 35.4 +/- 2.6 to 23.6 +/- 3.5 mU/ml after 5 h of hemodialysis (p = 0.0001 by paired t-test) and from 39.5 +/- 8.6 to 27.5 +/- 8.9 mU/ml (p < 0.01) respectively. In contrast to AC dialysis, Bi dialysis failed to change the plasma EPO concentration (from 32.3 +/- 4.1 to 30.3 +/- 4.7 mU/ml after 5 h of hemodialysis). Conclusions AC but not BI hemodialysis shows a significant suppressive effect on plasma EPO levels in anemic CRF patients in spite of a significant decline in pO2. Factors other than pO2 seem to be involved in the regulation of EPO secretion in CRF patients during AC dialysis.

The present paper is a concise summary of contemporary knowledge of lipoprotein(a). Increased lipoprotein(a) concentration is an independent risk factor for atherogenesis. The treatment of choice of increased lipoprotein(a) concentration is causal--for example treatment of the nephrotic syndrome or renal transplantation. If this is not amenable, careful monitoring and elimination of additional risk factors of atherogenesis are mandatory.

Presence of elevated plasma levels of erythropoietin (EPO) has been reported both in polycythaemic and normocythaemic patients with chronic obstructive pulmonary disease (COPD). The present study aimed to elucidate in what extent prolonged erythropoietin half-life time (T1/2EPO) is involved in the pathogenesis of elevated plasma EPO levels in patients with COPD. Seven normocythaemic patients (5 men and 2 women) with CODP and 6 healthy controls (4 males and 2 females) were examined. In all examined subjects half-life time of erythropoietin was determined after i.v. administration of EPO in a dose of 50 U/kg b.m. In COPD patients the T1/2EPO value was 5.98 +/- 0.67 hours and did not differ from that found in healthy controls (5.87 +/- 0.35 h). Results obtained in this study suggest participation of factors other than prolonged half-time of erythropoietin in the pathogenesis of polycythaemia in patients with COPD.

Erectile dysfunction is present in approximately 50% of diabetic men. It is most often caused by diabetic neuropathy and angiopathy but psychogenic factors are also of importance. Treatment includes: elimination of risk factors, psychotherapy, pharmacologic treatment and implantation of penile prosthesis.

The increase in glomerular filtration rate after an amino acid load, the so-called renal reserve, was found to be impaired in the aged rat. Renal diseases progress more rapidly in the elderly. Whether the renal reserve predicts progression of renal disease is controversial, however, and generally little information on renal reserve in elderly subjects is available. We examined renal hemodynamics before and after an amino acid infusion in 15 healthy normotensive subjects of young age (median age, 26 years [23 to 32]) and in 10 of old age (70 years [61 to 82]). Median basal inulin (Cin) and paraaminohippurate (Cpah) steady-state clearances were significantly lower in the elderly (102 and 339 mL/min/1.73 m2) than in the young subjects (122 and 647 mL/min/1.73 m2), but virtually all GFR values of the elderly were still within the normal range. The median percent rise of Cin was +16% in young and +17% elderly subjects (independent of gender). A well-preserved renal reserve was also confirmed by two other studies; one in chronically ill elderly patients treated for various nonnephrological diseases using an amino acid load and the other in healthy elderly volunteers in which renal reserve was tested with a protein (meat) meal. The mean absolute renal reserve in the three cohorts studied was between 16 and 26 mL/min/1.73 m2, the oldest patient studied was 89 years. The results of these studies document that in humans renal functional reserve is preserved at least until age 90 years in women and men.

The increased level of ferritin is known as a nonspecific marker of inflammatory processes and neoplasms. A purpose of the article was to indicate concentration of ferritin in blood serum before treatment of 33 patients with cancer of larynx and 16 patients with malignant neoplasms of maxillo-ethmoid complex. The patients with cancer of larynx were characterized by significantly high level of ferritin in comparison to patients with malignant neoplasms of maxillo-ethmoid complex (p < 0.05) and to healthy people (p < 0.05) (respectively 241.9 +/- 154.9; 106.9 +/- 45.4 and 125.0 +/- 30.4 ng/ml). Contrary to patients with cancer of larynx patients with malignant neoplasms of maxillo-ethmoid complex did not differ in significant level of ferritin from healthy people. The concentration of hemoglobin in blood in both groups of patients was similar and was characteristically lower than values obtained in healthy people. The results achieved suggest that indicating of ferritin can be helpful while making a differentiation between cancer of larynx and malignant neoplasms of maxillo-ethmoid complex.

This study aimed to assess the influence of short-term therapy with recombinant human erythropoietin (rhEPO) on selected parameters of humoral and cell mediated immunity in haemodialyzed uraemic patients (HDP). In 12 HDP before, and after 1 and 3 months of rhEPO therapy the following parameters were assessed: nitroblue tetrazolium (NBT) test, NBT test after latex stimulation, number of B, T and CD4 and CD4- and CD8-positive T lymphocytes, serum concentrations of IgG, IgA and IgM. The number of granulocytes with a positive NBT test was significantly higher after 3 months of rhEPO therapy. The number of granulocytes with a positive NBT test after latex stimulation increase both after 1 and 3 months of rhEPO therapy but significantly only after 3 months of treatment. The number of CD4-positive T lymphocytes increased significantly after 3 months of rhEPO therapy, while the number of CD8-positive lymphocytes decreased significantly after 1 month of therapy. The CD4/CD8 ratio increased significantly after 3 months of rhEPO therapy. Serum IgA concentration increased significantly after 1 and 3 months, while serum IgG level only after 3 months of rhEPO therapy. From the results obtained in this study it follows that rhEPO therapy exerts a positive effect on function of both T and B lymphocytes in haemodialyzed uraemic patients.

The present study aimed to assess the function of proximal and distal tubules in patients with simple renal cysts. Thirty-one patients with simple renal cysts and 10 healthy subjects were examined. Based on the cyst fluid/plasma sodium ratio, 25 cysts were found to be of proximal origin and 6 of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-microglobulin (beta-2-MG), sodium, potassium, calcium, phosphorus and total protein were assessed. Urinary excretions of sodium, potassium, calcium, phosphorus, beta-2-MG and Tamm-Horsfall protein (THP) were also estimated. Fractional excretion of beta-2-MG was calculated. The concentrations of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0 36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin. Plasma beta-2-MG concentration was significantly higher in patients with proximal and undetermined cysts than in the control group (4.35 +/- 0.34 and 4.11 +/- 0.74 vs. 1.89 +/- 0.1 mg/l, p < 0.001). Urinary beta-2-MG excretion was also significantly higher in both groups of patients than in healthy subjects (474.8 +/- 165.9 and 346 +/- 94 vs. 100.2 +/- 19.6 micrograms/24 h, p < 0.05). Urinary THP excretion was significantly higher in patients with proximal cysts than in healthy subjects (31.0 +/- 5.1 vs. 16.3 +/- 2.5 mg/24 h, p < 0.05). From the results obtained in this study it seems that patients with simple renal cysts of proximal origin are characterized by abnormal tubular handling of beta-2-MG, and calcium and THP excretion. Thus, in patients with proximal cysts presence of a latent renal tubulopathy seems to be likely.

Using RIA method, serum erythropoietin (EPO) levels were measured in 13 patients undergoing autologous bone marrow transplantation (ABMT) and 4 patients with autologous peripheral blood stem cell transplantation (APBSCT) before and at the end of conditioning regiment as well as at the 3rd, 7th, 10th, 14th, 20th i 30th day after ABMT in correlation with actual haemoglobin (Hb) value. Statistically significant increase in EPO level was observed at days 0 to +14 (p < 0.01) with the maximum at day 3. The correlation between increased EPO level and decreased Hb was observed.

Unlabelled: This study aimed assess function of renal tubules in patients undergoing conditioning regimen before bone marrow transplantation. The examined group comprised 19 patients. 13 of them underwent autologuous bone marrow transplantation (ABMT), or autologuous peripheral blood stem cells transplantation (APBSCT). These patients were treated with Cyclophosphamide (Cy) (120 mg/kg), Etoposide (1.6-1.8 g/m2) and Carmustine (400-450 mg/m2). The remaining 6 patients underwent allogenic bone marrow transplantation (BMT). They were treated with Cy 200 mg/kg or with Cy 120 mg/kg and Busulfan 16 mg/kg (doses given are the total amount or respective drugs were administered during the whole conditioning regimen). Urinary excretion of beta-2MB and THP was assessed a) before the conditioning regimen was started, b) one day before completion of it, and c) one day before bone marrow transplantation. In ABMT/APBSCT patients urinary excretion of beta-2-MG was significantly higher before and during conditioning regimen as compared with baseline value (3309 +/- 1123.7 vs 3919 +/- 1417.8 vs 246.7 +/- 50.3 mg/24h, respectively, p < 0.05). Urinary excretion of THP in these patients was significantly higher only during the conditioning regimen (90.6 +/- 14.3 vs. 30.4 +/- 6.24 mg/24h, p < 0.0002). In BMT patients conditioning regimen was followed by similar but less marked changes of urinary excretion of beta-2-MG and THP as compared with ABMT/APBSCT patients., Conclusions: 1. Conditioning regimen do influence significantly function of proximal and distal renal tubules. 2. The extent of disturbed function of renal tubules seems to depend on kind of medication that is given during the conditioning regimen.