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Objective: Most of the Polish territory has been classified as an iodine-deficient and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. In 1997 the obligatory model of iodine prophylaxis was implemented. Our investigations were aimed at the effectiveness of iodine prophylaxis in Poland. Methods: We assessed urinary iodine excretion and goiter prevalence in 5663 children aged 6–12 yr. The population of children from the same 27 schools was investigated from 1992 to 1994 (1406 girls and 1244 boys) and from 1999 to 2005 (1563 girls and 1450 boys) using identical laboratory and ultrasound methods. Results: We found significant increase in iodine urinary concentration (median 52 μg/l vs 93 ug/l, p

Pituitary metastases, though very uncommon, may cause endocrine and neurosurgical problems. The clinical manifestation of such metastases is highly variable. Most of the metastatic pituitary tumours are oligosymptomatic. We report two cases of metastatic pituitary lesions. The first patient, a 52-year old female, with metastatic breast cancer, developed symptomatic anterior pituitary insufficiency. The second patient, a 46-years old female presented with signs and symptoms of pituitary apoplexy and visual impairment due to metastasis from renal cancer. None of them was diagnosed with diabetes insipidus, the most common manifestation related to pituitary metastatic mass.

UNLABELLED Adrenocortical oncocytoma is extremely rarely found. Only a little more than thirty cases of adrenal oncocytoma, mainly nonfunctioning and benign, have been reported in the literature. Adrenal mass 150 x 160 x 172 mm in size and enlarged periarterial lymph nodes were found in CT examination performed in 51-year-old male. Main complaints: weight loss, general asthenia and abdominal pain. PHYSICAL EXAMINATION elevated blood pressure (180/120 mmHg), no features typical of Cushing's syndrome. Abnormal laboratory findings: oral glucose tolerance test revealed diabetes, elevated serum dehydroepiandrosterone-sulfate (1101.9 microg/dl; normal, 59-452), elevated serum cortisol following overnight 1 mg dexamethasone test (5.1 microg/dl; normal

Today, the posterior retroperitoneoscopic technique has become a standard procedure in adrenal surgery. The procedure allows direct access to the adrenal glands, but it seems to be difficult because of the uncommon anatomic view. This study compares the learning period of the new procedure of "posterior retroperitoneoscopic adrenalectomy" in the primary invention phase and the secondary introductory phase in a different hospital 10 years later.The analysis included 100 posterior retroperitoneoscopic adrenalectomies (PRA) and involved 50 procedures in each center. Group A consisted of 44 patients (14 males, 30 females; age: 48.7 +/- 14.5 years) undergoing surgery between 07/1994 and 8/1996 (24 right, 26 left; 8 Cushing adenomas, 14 Conn adenomas, 11 pheochromocytomas, 7 nonfunctioning adrenocortical adenomas, 10 ACTH-dependent adrenal hyperplasias). Group B consisted of 50 patients (12 males, 38 females; mean age 59.3 +/- 10.7 years) operated between 01/2004 and 01/2006 (28 right, 22 left tumors; 5 Cushing adenomas, 12 Conn adenomas, 4 pheochromocytomas, 29 nonfunctioning adrenocortical adenomas). All PRAs were performed with the patient in the prone position with 3-4 trocars placed caudally in the region of the 11th and 12th ribs. In group A, the surgical team developed the technique of PRA themselves. Before their first PRA, the surgical team of group B was introduced to the technique by the group A surgeons and afterwards were supervised continuously.No serious intraoperative or postoperative complication occurred in either group. Group A experienced 7 conversions to open surgery, whereas group B had one conversion and one early reoperation due to bleeding (P = 0.03; chi(2)-test). The mean operative time was 117 +/- 41 minutes versus 83 +/- 35 minutes (group A and B respectively; P0.001; t-test). Estimated blood loss was similar in the two groups (47.2 +/- 46.2 ml versus 54 +/- 16.3 ml, group A versus B, respectively; P = 0.36; t-test).The study demonstrates the feasibility, safety, and reproducibility of the new surgical method of PRA both when it is employed in the early phase of invention, as well as when performed by surgeon-learners. After comprehensive training, the operative time and conversion rate are dramatically reduced, allowing for a short learning period.

Summary Objective To determine the sensitivity and positive predictive value (PPV) of subtraction scintigraphy (SS) vs. ultrasonography (US) of the neck combined with rapid intact parathyroid hormone (iPTH) assay in US-guided fine-needle parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach. Design The results of SS for localization of parathyroid adenoma were determined in 121 patients with primary hyperparathyroidism (pHPT) and compared with findings at surgery and with the results of US alone (in patients without nodular goitre) and US in combination with the iPTH assay in US-guided fine-needle aspirates (FNAs) of suspicious parathyroid lesions (in patients with concomitant nodular goitre). Patients All 121 patients had biochemically documented pHPT; all were referred for first-time surgery. Measurements SS was performed with 99mTc-sestamibi and 99mTc-pertechnetate. High-resolution US of the neck was performed by a single endocrine surgeon and combined with US-guided FNAs of suspicious parathyroid lesions in all patients with nodular goitre (n = 43). Results The sensitivity and PPV of SS were significantly higher in patients without vs. with goitre (89·3% and 95·7%vs. 74·3% and 76·5%, respectively; P

BACKGROUND: Iodine prophylaxis in Poland started in 1935 and has been interrupted twice: by World War II and in 1980 for economic reasons. Epidemiological surveys carried out after the Chernobyl accident in 1989 as well as in 1992/1993 and in 1994 as a 'ThyroMobil' study, revealed increased prevalence of goitre in children and adults. Ninety per cent of Poland was classified as an area of moderate iodine deficiency, and 10%, in the seaside area, as mild iodine deficiency territory. Iodine prophylaxis based on iodisation of household salt was introduced again in 1986 as a voluntary model and in 1997 as a mandatory model with 30+/-10 mg KI/kg salt. OBJECTIVE: The evaluation of the obligatory model of iodine prophylaxis in schoolchildren from the same schools in 1994 and 1999. METHODS: Thyroid volume was determined by ultrasonography. Ioduria in casual morning urine samples was measured using Sandell-Kolthoff's method, within the framework of the ThyroMobil study. RESULTS: Goitre prevalence decreased from 38.4 to 7% and urinary iodine concentration increased from 60.4 to 96.2 microg/l mean values between 1994 and 1999. In four schools the prevalence of goitre diminished below 5%. In 1999, 70% of children excreted over 60 microg I/l, and 36% over 100 microg I/l, whereas in 1994 the values were 44 and 13% respectively. CONCLUSION: The present findings indicate that iodine prophylaxis based only on iodised household salt is highly effective.

Obesity is an effect of interaction of genetic and environmental factors. It leads to development of serious complications, like insulin resistance, diabetes type 2, arterial hypertension and atherosclerosis. The adipose tissue is a place where many adipokines, mainly leptin and adiponectin, are produced and released. Adiponectin, which blood level is decreased in obesity is considered to have antidiabetic and antiatherogenic effect. While leptin, which blood level is increased in obesity, is associated with regulation of appetite, energy expenditure, lipids and carbohydrates metabolism, cellular differentiation and puberty. The aim of this research was estimation of leptin to adiponectin ratio (Lep/AdipoR) in the blood of patients who came from obese families. The study was carried out on 80 patients (43 female and 37 male). The antropometric examination with proportional contents of adipose tissue, oral glucose tolerance test (OGTT) and oral postprandial lipaemia test (OPLT) were performed. The fasting level of leptin (Elisa), adiponectin (Elisa) and von Willebrand factor (Elisa) lipidogram were performed. During OGTT blood was sampled in intervals of 30 minutes up to 2 hours, to measure glucose and insulin concentration. In fasting state and then every 2 hours after consumption of a high-fat meal (OPLT), (0, 2 hours, 4 hours, 6 hours, and 8 hours) blood was sampled for: trigliceride, glucose, free fatty acids and insulin concentration. The insulin resistance ratio (HOMA-IR) was calculated for each patient according to the formula: [insulin (mU/ml) x glucose (mmol/l)]/22.5. Adiponectin blood level was higher in the examined women than in men. It (regardless to the sex) was decreased with decrease of body mass index (BMI). Blood level of leptin (also higher in women) was positively corelated with BMI. In the group of patients with low level of adiponectin in serum (below 5mg/ml in men and 10 mg/ml in women) the highest con- centration of glucose and insulin in successive time points of OGTT and the highest HOMA-IR value (4.79 in men and 4.38 in women) were observed. In patients with high level of leptin in serum (over 20 ng/ml), the highest concentration of insulin, especially in 2 hours of the test (101.75 micromol/ l), and the highest HOMA-IR value (4.30 during OPLT ) were found. The Lep/AdipoR in the blood was significantly higher in obese patients in comparison to people with normal BMI. Lep/AdipoR had high correlation factor with BMI (r = 0.6267, p0.001), with HOMA-IR (r = 0.5080, p0.001), with fasting insulin concentration (r = 0.5444, p0.001), and in 2 hour of OPLT (r = 0.5552, p0.001). ROC analysis (Receiver or Relative Operating Characteristic) showed that with reference to obesity Lep/AdipoR had the highest discriminatory value. The estimation of Lep/AdipoR can be used as additional index in evaluation of obesity complications such as insulin resistance and endothelial dysfunction.

Currently, there is growing interest in the use of the beta emitter (90)Y in systemic therapy in oncology. For successful therapy, an appropriate ligand is chosen to carry the isotope to the place of its action. As well as performing this function, the type of the ligand influences both the course and the side effects of the treatment. For RIT of lymphomas, bone marrow becomes the critical organ; in NET patients treated with labelled somatostatin analogues, increased kidney irradiation can occur. The aim of this study was to evaluate the side effects of therapy using 90Y associated with different ligands, depending on the charge to critical organs after treatment in two groups of patients: those with neuroendocrine tumours and those with non-Hodgkin's lymphomas.32 patients with histopathologically confirmed NET treated with (90)Y-DOTATATE (7.4 GBq/m(2) cumulative dose) and 30 NHL patients treated with (90)Y-ibritumomab tiuxetan (1200 MBq max dose) were enrolled in the study. The kidney function and changes of blood indices were assessed during the course of the therapy.59% of NET patients treated with (90)Y-DOTATATE displayed transient reduction of blood indices, the largest after cycles III and IV of therapy. After 5 months an increase in creatinine level was noticed, but no statistically important changes in creatinine level and GFR were observed. In the group of patients with NHL, the change of haematological indices after RIT concerned mainly PLT, ANC and WBC. The reduction of the average PLT and WBC values started in the first weeks after the treatment application, reaching nadir in the 6(th) week and 8(th) week, respectively. No life threatening infections were observed in either group of patients.After treatment with the use of the (90)Y radionuclide, no significant treatment toxicity, including disorders involving the critical organs for both types of therapies, was found in the groups of neuroendocrine tumour and non-Hodgkin's lymphoma patients.

Ibritumomab, an (90)Yttrium ((90)Y) labelled radioimmunoconjugate, is registered in Europe to treat follicular lymphomas. Its mode of action combines the selectivity of monoclonal antibodies with the efficiency of radiotherapy, making it a unique and useful therapeutic agent. This paper is for haemato-oncologists with a decent practice in lymphoma therapy, who have not yet used ibritumomab themselves. It summarizes clinical trials with radioimmunotherapy, indicating clinical situations where it may be specifically useful.

Ibritumomab is an (90)Yttrium ((90)Y) labelled radioimmunoconjugate registered to treat follicular lymphoma relapsing or refractory after Rituximab therapy. Combining the specificity of anti CD20 monoclonal antibodies with the efficacy of radiotherapy, it is particularly effective in patients with advanced stages of disease with generalized lymphadenopathy.Twenty-one patients with follicular lymphoma, after failing 2-5 lines of previous treatment, were subjected to radioimmunotherapy in three Polish Lymphoma Research Group (PLRG) centres. Ibritumomab infusion was followed by 2 doses of Rituximab (250 mg/m(2) at day -7 and 0) to enhance its biodistribution. Radioimmunoconjugate was prepared in the Nuclear Medicine Departments of participating centres based on patient weight and full blood count results (14.8 MBq/kg, max 1200 MBq, reduced to 11.1 MBq/kg in cases with blood platelet 100,000-150,000 or leukocytes 1500-2000). 14.8 MBq/kg (0.4 mCi/kg) 100 thousand to 149 thousand/mm(3) platelets 11.1 MBq/kg (0.3 mCi/kg)The primary endpoint of the study was the assessment of response rate and haematological toxicity. Objective responses were observed in all patients, with 10 partial and 12 complete regressions. Cytopenia, starting 3-4 weeks after radioimmunotherapy, reflected haematological toxicity - the only important side effect. Thrombocytopenia was more pronounced, with platelet counts of50,000/ul in every second patient. One patient developed myelodysplastic syndrome 21 months after the procedure. After the medium time of follow up over 2 years, 2 patients died. Median progression free survival (secondary study endpoint) was 15 months.Ibritumomab radioimmunotherapy is an efficient method of palliation treatment of heavily pre-treated follicular lymphoma patients, failing numerous previous treatment lines. Earlier application increases the number of complete responses and prolongs progression free survival.

Body mass reduction and regular physical training form part of a strategy to treat disorders of carbohydrate metabolism associated with obesity. Evidence shows that even a slight reduction in body mass may improve carbohydrate tolerance, lipid profile and insulin resistance, reduce insulin levels and finally delay or reduce risk of diabetes mellitus. Multiple studies, including prospective studies confirm the independent protective effects of physical training against future development of type 2 diabetes mellitus. Myocardial infarction is a severe complication of atherosclerosis. Patients with glucose intolerance have a 2-fold higher risk of dying. Impaired glucose tolerance is negatively associated with prognosis in patients after myocardial infarction. Glucose intolerance accompanies hyperinsulinemia, a major indicator of insulin resistance.The aim of the study was to analyze the effect of physical training on hyperinsulinemia/ insulin resistance in patients after myocardial infarction (MI) with impaired glucose tolerance (IGT).31 men aged 37-69 years (mean 51 +/- 7.4) with IGT 3.5 years after MI, in NYHA class I and II participated in the study. Group A (n=16 men) underwent supervised physical training and group B (n=15) received standard information on physical training. Tissue glucose disposal using normoglycemic glucose clamp technique, fasting insulinemia, glycemia during OGTT, lipid profile, BMI and body mass composition were obtained in all patients.The groups were matched for age. There were no differences in BMI, percent fat content, blood pressure, diet, smoking status and pharmacotherapy. Glycemia during baseline OGTT did not differentiate the groups, either. Analysis of insulinemia and glycemia during OGTT at baseline and at 12 weeks after regular physical training showed lower levels of insulinemia and glycemia compared with baseline levels in group A (fasting glycemia 6.41+/-0.46 vs. 4.8+/-0.32 mmol/l, p0.001; fasting insulinemia 59.42+/-38.9 vs. 27.42+/-26.5 umol/l, p0.001). A similar analysis in group B did not reveal any significant differences (fasting glycemia 6.17+/-0.49 vs. 6.18+/-0.46 mmol/ l; fasting insulinemia 61.86+/-48.5 vs. 68.86+/-78.5 umol/l). Mean tissue glucose disposal in the whole study population was 2.96+/-1.03 mg/kg bm/min.The present findings indicate the beneficial effects of regular physical training on the reduction of fasting insulinemia in patients after myocardial infarction with insulin resistance and improve lipid profile. In patients after myocardial infarction standard recommendations concerning physical activity are not well realized. It seems that better compliance, more strict control and motivation of patients can result in better metabolic control.

According to the traditional model of pathogenesis of type 1 diabetes - it develops in genetically susceptible individuals in whom environmental factors trigger an autoimmune process of beta-cell destruction. Although susceptibility may be inherited, there is a growing body of evidence showing the role of environmental factors that might not only trigger but also perpetuate the chronic autoimmune process. These factors may exert their action long before the disease manifests itself clinically, which significantly hampers their identification. Three groups of environmental factors that were most widely studied include of viral infections, feeding patterns in infancy and toxic compounds (especially nitrites). Other factors possibly playing a role in modifying the development of the disease are vaccinations, psychological stress and climatological factors. The authors summarize the data supporting the role of environmental factors in the development of the disease and show a more recent model of type 1 diabetes pathogenesis. It may partly explain why the disease incidence increased has so much in the last three decades despite markedly improved hygiene and health care standards.

Chronic alcoholism leads to organic damages of nervous system, the liver and the endocrine system. The aim of the study is to evaluate pituitary-gonadal axis in males chronically dependent with alcohol.The study group consisted of 50 alcohol dependent men aged 27 to 53 years (40.7 +/- 6.6) treated at the Ward of Toxicology and Environmental Diseases (Detoxification Unit). Al-cohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. In all the patients anthropometrical measurements and abdominal ultrasonography were performed as well as blood pressure was measured. Levels of gonadotropin, total testosteron, PRL were determined, thyroid and adrenal gland function were assessed and oral glucose tolerance test (OGTT) was performed in all patients. Activity of the liver enzymes, urea and creatine concentration were determined. Erectile dysfunction was assessed using IIEF. 5 questionnaire: in those patients who receivedor =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire.Alcohol dependency longer than 15 years was stated in 25, longer than 10 years in 9, and longer than 5 years in 16 of examined patients. The moderate withdrawal syndrome was diagnosed in 22, severe withdrawal syndrome in 26 and very severe withdrawal syndrome in 2 of the patients. BMI ranged from 15.8 to 33.8 kg/m2 (mediane 24.67; +/- 0.54 kg/m2). In 24 men erectile dysfunction was diagnosed using IIEF5 questionnaire. No significant difference was noted between level of total testosterone and PRL in the group with or without erectile dysfunction (testosterone: 5.07 +/- 2.41 vs. 4.54 +/- 2.74; PRL: 330.2 +/- 214.2 vs. 307.4 +/- 258.2). Gonadropine level in the group of men with erectile dysfunction was significantly higher than that without erectile dysfunction (LH: 7.4 +/- 5.2 vs. 4.38 +/- 2.23, p0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p0.05).The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics.Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y).The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

The aim of the study was to evaluate the myocardium function in acute paracetamol poisoning using 19mTc-MIBI GSPECT.Under examination there were 25 acutely paracetamol poisoned patients (age: 24.5 +/- 6 years) treated at the Ward of Toxicology and Environmental Diseases. The control group necessary to perform quantitative analysis of myocardial scintigraphy consisted of 20 people examined in Nuclear Medicine Unit with normal results of 99mTc-MIBI GSPECT examination.The quantitative analysis of the heart scintigraphy (GSPECT) revealed that, the average value of left ventricle ejection fraction (EF) in examined women and men after paracetamol poisoning was lower than in control group, while end diastolic (EDV) and end systolic volumes (ESV) were higher; these differences were not statistically significant. Indicators of regional wall motion of the left ventricle were lower for the most of the heart segments. According to the control group, they were significantly lower for anterior and inferior LV segments. Wall thickening analysis revealed the impaired systolic thickening of majority of heart segments in examined group of patients; the wall thickening was the lowest for infero-lateral and septal segments in women and for inferior, infero-lateral and anterior segments in men.The quantitative analysis of myocardial perfusion scintigraphy (99mTc-MIBI GSPECT) with wall motion and wall thickening assessment, showed that the left ventricle function was usually diffusely depressed in paracetamol poisoned patients. The disturbances of regional wall motion of anterior and inferior wall (LV) were mainly visible.

The aim of the study was to assess the relationship between alcohol consumption and insulin resistance in the adult Kraków's inhabitants.6000 subjects at age 35-75, participants of the Polish Multicenter Study on Diabetes Epidemiology, were randomized and invited to the study. Finally in 2838 participants the standardized questionnaire examination of the life style especially alcohol consumption was performed. In all persons anthropometric and blood pressure examination was performed. Fasting lipids, fasting and after glucose load glucose and insulin were determined. Glucose tolerance was determined in all study participants according WHO 1999 criteria. Insulin-resistance was defined as the highest quartile of the distribution of the HOMA-IR index assessed for population with normal glucose tolerance (NGT).In examined group 472 (29.2%) women and 150 (12.2%) men were abstainers. Alcohol consumption below 10 glday declared 68.4% of women and 54.9% of men, between 10 and 30 g/day--2.0% of women and 24.7% of men, above 30 g/day--8.2% of men and 0.4% of women. In men with normal glucose tolerance the lowest HOMA-IR we observed in the group drinking daily above 30 g of alcohol (2.05 +/- 1.3). In men with impaired glucose tolerance the lowest HOMA-IR was observed in the group drinking daily below 10 g of alcohol, the highest in the group of abstainers (2.81 +/- 2.04 vs. 3.23 +/- 1.72; ns). For men drinking between 10 and 30 g of alcohol daily decreased the risk of insulin resistance at 40% (OR = 0.6; 95% CI: 0.37-0.96), drinking above 30 g daily decreased the risk at 49% (OR = 0.51; 95% CI: 0.27-0.96). We didn't observed this relationship in the group of women.Our results confirm positive impact of daily alcohol intake above 10 g for the risk of insulin resistance in the group of men.

The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics.An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education.In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission wasor = 7.8 mmol/l; in u 3.6% (78 males and 50 females)or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission wasor = 3.5 mmol/l. Control fasting glucose level ofor = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent.A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

There are only few studies on the prevalence of the metabolic syndrome in Polish population. The aim of the study was to assess the prevalence of the metabolic syndrome according to NCEP definition in adult inhabitants of Krakow.The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure, fasting total cholesterol and fasting glucose were measured. In those with total cholesterol5.2 mmol/l additional triglicerides and HDL-cholesterol were measured.40989 people (67.2% women and 32.8% men) aged 25 to 97 (54.1 +/- 14.1 years) were examined. In 19,4% of the examined population the MS was diagnosed (20.9% women and 16.2% men). In age group below 55 years the MS was more frequent in men than in women. Impaired glucose tolerance was found in 5394 study participants (3239 women and 2155 men). Mean systolic blood pressure was higher in men than in women (131.5 +/- 16,1 vs 127.0 +/- 17.5, p0.0001), the same was found for diastolic blood pressure (81.5 +/- 0.3 vs 78.6 +/- 9.6 p0.0001). 33.5% of women and 34.9% of men (p0.01) were treated from hypertension. In age group below 55 years men were more frequently treated due to hypertension than women (p0.001). In 8.7% of women and 14.1% of men (p0.001) newly diagnosed hypertension was found. In all age groups untreated hypertension was more frequent among men than in women. In 26.1% women and 33.5% men hypertriglicrdymia was found. In age group below hypertiglicerydemia was more frequent in men than in women (p0.001). Low HDL-cholesterol was found in 20.9% of women and 10.1% of men (p0.001). Visceral fat distribution was found in 19.9% of men and 33.3% of women.The MS was found in 20% of examined inhabitants of Krakow. Special attention should be paid to high prevalence of the MS among men younger than 45 years, as well as high prevalence of hypertriglicerydemia and newly diagnosed hypertension present in this group of men. The study results confirm the necessity of implementation of screening and early prevention of cardiovascular disease programs especially focused on younger men.

The aim of this study is to present a case of a 36-year old male with a rare thyroid malignancy--a primary thyroid lymphoma. The patient was admitted to the Department of Endocrinology due to a rapidly enlarging left-sided tumor of the neck and hoarseness lasting for 2 weeks. The only abnormality found on biochemical testing was a slightly elevated titre of anti-TPO antibodies. On X-ray examination, both a compression and deviation of the trachea was found. Ultrasound examination of the neck revealed a left-sided thyroid lesion and fine needle aspiration (FNA) was performed under ultrasound guidance. A monotonous population of mid-size lymphoid cells was found with negative immunocytochemistry for thyroglobuline and CD 68. After hematological and pathological evaluation the FNA report was considered as non-diagnostic. Taking into consideration the presence of rapidly occurring compressive symptoms caused by a tumor of unknown cytological origin, the patient was referred to urgent thyroid surgery. Pathological report of postoperative specimen allowed for the final diagnosis of a malignant lymphoma originating from non-Hodgkin B cells of the thyroid gland; diffuse large B-cell lymphoma (DLCL) according to WHO classification. L-thyroxin substitution therapy, chemo- and radiotherapy were used after the operation. The described case of a very rare type of primary thyroid malignancy illustrates difficulties which can be encountered in diagnostic approach and therapeutic decision making in patients with rapidly enlarging thyroid tumors.

Graves disease and Hashimoto disease are due to inappropriate activation of immunological system and production of the antibodies against thyroid gland. The aim of the study was to estimate potential risk of other autoagressive and allergic disease in patients with Hashimoto or Graves disease. 255 patients with Graves disease (216 females and 39 males) and 69 patients (63 females and 6 males) mean age 53.6 +/- 13.7 years were examined. The control group consists of 200 patients (175 females and 25 males) mean age 61.98 +/- 14.35 years with nodular goitre. There were 74 cases (i.e. 22.8%) of coexisting autoimmunological or allergic disorder among the patients with autoimmunological thyroid disorders (36 patients with Graves disease and 38 patients with Hashimoto disease). There were 20 cases of type 1 diabetes mellitus, 13 cases of bronchial asthma, 16 cases of Addison' disease, 4 cases of rheumatoid arthritis, 1 case of scleroderma, 4 cases of systemic lupus erythematosus, 2 cases of colitis ulcerosa, 2 cases of myasthenia gravis, 6 cases of Addison-Biermer disease, 3 cases of primary biliary cirrhosis and 3 cases of rhinitis allergica. There were 3 cases (1.5%) of additional auto-immunological or allergic disorder among the control subjects--1 case of type 1 diabetes mellitus and 2 cases of bronchial asthma. Because of the higher risk of coexisting auto-immnunologi-cal or allergic disorder, patients with autoimmunological thyroid disorders should be closely controlled.

In Poland, similarly like in the other European countries type 2 diabetes screening and prevention projects have been run. In Krakow, Krakow's Municipality had undertaken a decision of financing a prevention program directed to adult inhabitants of the city. The aim of the study was to assess the prevalence of the glucose metabolism disturbances in adult inhabitants of Krakow city.The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure and fasting glucose were measured. Diabetes risk score (DRS) and fasting glyceamia were used to classify patients to receive oral glucose tolerance test (OGTT).40989 people (67.2% women and 32.8% men) aged 25 to 97 were examined. 12495 people received OGTT, in 1858 fasting glycaemia measurement was repeated. In 15.1% of men and 12.7% of women impaired glucose metabolism was found (p0.01). IFG was found in 5.9% men and 4.7% women (p0.01). The prevalence of IGT was the same in men and women (3.7% vs 3.8%, ns). Newly diagnosed diabetes type was found in 5.5% men and 4.2 % of women (p0.01). The prevalence of impaired glucose metabolism was increasing with age in men and women, in all categories of glucose disturbances, age related trends were statistically significant. Overweight was more frequent in men than in women (50.3% vs 36.8%, p0.0001), while obesity was more frequent in women compared to men (20.7% vs 19.5%, p0.02). Obesity was statistically more frequent in people with impaired glucose metabolism compared to those with normal glucose tolerance. Overweight was more frequent in women with impaired glucose metabolism compared to women with normal glucose metabolism, no relation with overweight was observed in men.The prevalence of newly diagnosed type 2 diabetes is increased in people aged over 55, what confirms the necessity of screening in this group of age. Due to more prevalent newly diagnosed type 2 diabetes and IFG in men, in all age groups implementation of routine screening for impaired glucose metabolism in men aged over 35 should be considered. Results of the study confirm the importance of the implementation of early prevention programs focused on lifestyle modification, especially addressed to men.

The new imaging techniques used during the last several years: ultrasound, computed tomography and magnetic resonance imaging have improved detection of non-functional adrenal tumours s.c. "incidentaloma". Incidence of adrenal incidentaloma is not very low. They are detected in about 0.35-4.36% CT examination. In most of cases incidentaloma are benign and gave no clinical signs; however primary adrenal cortex cancer and metastases of different cancers are not uncommon. The primary adrenal lymphoma is an extremely rare disease. The predominant group of patients are men over 50 years with other manifestations of non Hodgkin lymphoma. Most frequently both adrenal glands are affected and signs of adrenal insufficiency (despite weakness, fever and loss of weight) are present. In our paper we present a case of primary, unilateral lymphoma in a 19 year old women. It was discovered as incidentaloma in ultrasound examination. Hormonal examinations were normal, but the tumour size was indication for surgery treatment. The diagnosis was made by histological examination and adjuvant chemotherapy was administrated.

ObjectiveTo assess the prevalence of hyperthyroidism just after implementation of iodine prophylaxis among adults from an area with iodine deficiency.Study design and subjectsA total of 1648 adults (age 16 years and older) were sampled from an area of southern Poland during two nationwide epidemiological surveys. Of these, 1424 adults with negative medical history for thyroid disorders qualified for final analysis. The authors compared thyroid dysfunction in participants prior to (1989–1990) and after implementation of iodine prophylaxis (1997–1999).SettingThe southern part of Poland.ResultsWe found an increase in the serum concentration of anti-thyroid microsomal antibodies from 4.9% in the years 1989–1990 to 12.1% after introduction of iodised household salt (P − 1) significantly increased in the equivalent period from 4.8 to 6.5% (P = 0.009).ConclusionsWe concluded that a sudden rise in iodine intake after implementation of iodine prophylaxis among adults from the area with iodine deficiency may lead to an increase in thyroid autoimmunity and prevalence of hyperthyroidism. Those possible early side-effects appear to be only temporary and are acceptable when compared with the evident benefits of adequate iodine intake.

UNLABELLED Pulmonary carcinoids cause serious difficulties in imaging diagnostics in all stages of the disease. SRS holds great promise for detecting occult primary tu and metastatic lesions. (99m)Tc-EDDA/HYNIC-octreotate, a new scintigraphic agent, should significantly improve sensitivity of the diagnostics of carcinoids due to better affinity to SSR2 than (111)In-Octreoscan and the higher count rate obtained from (99m)Tc over (111)In. We present a case of a 40-year-old women operated on because of lung carcinoid tumour in 2002. The symptoms did not resolve after the operation and 5-OHIAA was still elevated. The thorax spiral CT revealed the focal lesion beneath carina. (111)In-Octreoscan and (99m)Tc-EDDA/HYNIC-octreotate SRS revealed two focal lesions in the mediastinum. (99m)Tc-EDDA/HYNIC-octreotate detected two additional lesions in the lower part of the right lung. Target/non-target count ratios of the lesions were as follows: (99m)Tc-EDDA/HYNIC-octreotate scans - 2,9, (111)In-Octreoscan- 2,1. PET-FDG examination revealed no pathology. Owing to severe bone pains and carcinoid symptoms the patient was referred for the 90Y-DOTA-octreotate treatment. CONCLUSIONS SRS with a new 99mTc marked somatostatin analogue - octreotate allows for a more sensitive detection of metastatic leasions in carcinoid tumours. The usefulness of 18F-FDG PET, widely used as a powerful imaging technique in clinical oncology, is limited in detection of carcinoid tumours due to the low proliferative activity.

Numerous reports of increasing incidence of type 1 diabetes worldwide, and similar tendency in children population in Poland prompted the study aiming at evaluating the incidence of type 1 diabetes in a population aged 15-29 years in Krakow area (voivodeship) in 1987-1999. The type 1 diabetes registry established in Chair and Department of Endocrinology CMUJ in 1986 was continued. To improve ascertainment two independent data sources were used: hospital departments and outpatient diabetic clinics. Definite inclusion criteria were assigned and data verified. Incidence rates and trends of incidence were calculated for gender and age groups, differences between the groups were analyzed. Incidence rates were standardized for the European population. The seasonality of disease occurrence was calculated. Registry ascertainment was assessed using "capture-recapture" method. Incidence of type 1 diabetes showed a significant increase in the whole group (0.32 new cases/100,000/year), mainly due to marked incidence increase observed in males (0.53). The oldest age group (25-29 years) showed the most rapid increase in diabetes type 1 incidence (1.07). Seasonality of disease occurrence was found in females. Mean ascertainment was 81%, with the lowest values in 1996-1999. The results obtained indicate that the increase of type 1 diabetes incidence in the age group 15-29 years in Krakow region was due to rapidly increasing incidence in males, especially those aged 25-29 years. Lack of disease occurrence seasonality in this group may indicate a role of other factors (associated with lifestyle or hormonal) responsible for such marked increase in young males, not seen in females. The study was terminated in 1999 due to new administrative division of the country and problems with data collection from the area of non-longer existing Krakow voivodeship.

The exact pathogenesis of Graves' ophthalmopathy and the possibility of causal treatment of this disease still remain unclear. Currently no standard treatment guidelines have been accepted. While treatment procedures have been established in specialized centres, management of complicated and long-lasting cases is always individual. We present an unusual case of Graves' ophthalmopathy accompanied by other autoimmune diseases.Our patient, MB, female, born in 1961, was diagnosed with Graves' disease 13 years ago. Recurrent hyperthyroidism and large goitre qualified her for strumectomy (performed twice) and long-term antithyroid treatment. Four years after her initial diagnosis, relapsing severe (ophthalmopathy index: 9 points, CAS: 7 points) occurred which persisted despite continuous administration of glucocorticoids. Due to imminent blindness, orbital decompression had to be performed, three times since. Concurrent autoimmune diseases: ulcerative colitis and seronegative rheumatoid arthritis were also stated. Two years ago, due to loss of vision acuity, rapid progression of exophthalmos and recurrence of hyperthyroidism, immunosuppressive treatment with azathioprine was undertaken over a period of 12 months. The present condition of the patient is satisfactory.Judging from the discussed course of treatment, in rare and difficult cases of proliferative ophthalmopathy, early immunosuppressive treatment other than glucocorticoids, should be considered.

Radio-guided surgery (RGS) is an intra-operative localising technique which enables identification of tissue "marked" by a specific radiotracer injected before surgery. It is mainly used for sentinel node mapping and for detection of parathyroid adenomas and other tumours, including neuroendocrine tumours of the gastrointestinal tract (GEP-NET). The aim of this study was to determine whether intra-operative radio-detection with the use of [(99m)Tc-EDDA/HYNIC]octreotate, a new somatostatin analogue, is able to reveal an unknown primary and secondary sites, thereby improving surgical treatment and the final outcome of GEP-NET.The study group included nine patients with suspected GEP-NET (four carcinoids, five pancreatic NET) localised with somatostatin receptor scintigraphy (with [(99m)Tc-EDDA/HYNIC]octreotate), who had negative results on other pre-operative imaging tests. At surgery, suspected tumours were measured in situ and ex vivo and precise exploration of the abdominal cavity was performed with the intra-operative scintillation detector (Navigator).Intra-operative gamma counting localised three carcinoids. In one patient SRS was false positive (owing to inflammatory infiltration). Compared with SRS, RGS revealed additional lymph node metastases in one case. RGS resulted in successful localisation of all pancreatic NET (the smallest lesion was 8 mm in diameter).[(99m)Tc-EDDA/HYNIC]octreotate SRS followed by RGS is a promising technique to improve the rate of detection and efficacy of treatment of GEP-NET, especially in the presence of occult endocrine tumours. The imaging properties of [(99m)Tc-EDDA/HYNIC]octreotate and the 1-day imaging protocol offer opportunities for more widespread application of this tracer followed by RGS in oncology.

Poland has one of the highest death rates for stomach cancer in Europe. Moderate iodine deficiency and in consequence high goitre prevalence led to the implementation in 1996 of a very efficient mandatory model of iodine prophylaxis, based on household salt iodisation (30 +/- 10 mg KI/1 kg of salt).The aim of the study was evaluation of incidence rate of stomach cancer and its possible relation to increased iodine consumption in the years 1992-2004.Iodine supply and effectiveness of iodine prophylaxis were evaluated on the basis of comparative analysis of goitre prevalence and ioduria in schoolchildren. To allow comparison between time periods with varying population age structures, the incidence rates of stomach cancer were standardized for age, using the "world standard population". The direct standardization method has been applied. For each sex, the time-trend of incidence rates was shown in graphs over the years 1991-2004.Evident increase in iodine consumption in this period of time was proved by rise in percentage of schoolchildren (6-8 years old) with ioduria above 100 microg/l from 11.4% in 1992-1993 to 52.9.1% in 2003. It was correlated with the decrease in goitre prevalence from 18.8% to 3.2% respectively. The 24-h thyroid uptake of (131)I in investigated population fell from 45.5% in 1986 to 26.8% in 1998. In Krakow the standardized incidence ratio of stomach cancer for men decreased from 19.1 per 100,000 to 15.7 per 100,000, and for women from 8.3 per 100,000 to 5.9 per 100,000 in the years 1992-2004. A significant decline of average rate of decrease was observed in men and women (2.3% and 4.0% per year respectively).Observed association between improved iodine supply and decrease of incidence of stomach cancer could indicate the protective role against stomach cancer of iodine prophylaxis in iodine deficient areas--further studies are necessary.

The aim of the study was to evaluate the impact of therapy with biphosphonates in patients with primary hyperparathyroidism and negative result of parathyroid scintigraphic imaging on increase of diagnostic sensitivity in repeated scans. Three female patients with diagnosed primary hyperparathyroidism and negative parathyroid imaging with subtraction 99m-Tc-MIBI scintigraphy were included into this prospective study. Patients had been receiving 70 mg of sodium alendronate orally, once a week for 3 months. After this period they were reevaluated with parathyroid subtraction scintigraphy. In all three patients a solitary area of uptake was found in the repeated scans. Patients were qualified for minimally invasive video-assisted parathyroidectomy. In two of them the repeated scans after treatment with biphosphonates were found to be true positive and in those two patients a solitary parathyroid adenoma was removed with video-assisted technique. In one patient a multiglandular disease was revealed intraoperatively basing on intraoperative iPTH assay and in that patient a subtotal video-assisted parathyroidectomy has been successfully completed. All three patients have been eucalcemic within the 6-months follow-up with iPTH serum values within the reference range. In conclusion, treatment with oral biphosphonates in patients with primary hyperparathyroidism and negative result of radionuclide parathyroid imaging, results in increased diagnostic sensitivity of repeated scans. This allows for successful minimally invasive parathyroid surgery in this group of patients with a predominant solitary parathyroid adenoma.

A case of GH and TSH secreting pituitary macroadenoma is reported. A 45-year-old female presented clinical features of acromegaly (the abnormal growth of the hands and feet, with lower jaw protrusion), diabetes mellitus, hypertension, nodular goiter and hyperthyroidism of unclear origin. NMR pituitary imaging revealed intra and extrasellar tumor. The laboratory examinations showed very high plasma levels of GH and IGF-1 and normal level of TSH coexisting with high plasma levels of free thyroid hormones. Pharmacological pretreatment with somatostatin analogues caused the substantial reduction of GH and TSH plasma levels. Histological and immunohistochemical examination of the tissue obtained at transsphenoidal surgery showed GH and TSH secreting adenoma. The laboratory examinations after surgery showed normal GH and IGF-1 plasma levels and reduced insulin requirement, what indicates radical operation. The very low plasma levels of TSH and free thyroid hormones after surgery and immunohistochemical examination suggest central hyperthyroidism due to TSH secreting pituitary tumor (thyrotropinoma).

Transsphenoidal surgery is the first-line therapy for patients with acromegaly, but can achieve biochemical control with normalization of somatomedin C in 40-80% of cases. All patients with continued growth hormone hypersecretion after neurosurgery require adjunctive therapy to prevent morbidity and premature mortality. The aim of our study was to evaluate the efficacy of long-acting somatostatin analog--octreotide LAR (OCT-LAR) as adjunctive therapy for patients with persistent disease. 14 adult subjects (age 45 +/- 15 years) were included into the study. All patients were diagnosed as having growth hormone secreting pituitary tumor and underwent transsphenoidal surgery (TSS). Radiotherapy (RT) was used as adjunctive therapy in 7 of investigated persons. In all subjects elevated level of somatomedin C was found, 9 have increased level of growth hormone (hGH) as well. After 6 months therapy with OCT-LAR we noticed drop in somatomedin C and hGH levels in all patients. Mean drop in somatomedin C level was 42.3% (p=0.001), in GH level was 52.3% (p=0.001). We found entire normalization of GH in 12 (85.7%) patients, nearly normalization of somatomedin C (level lower than 110% of normal upper limit) in 8 (57%) patients. We found no significant correlation between decrease in somatomedin C and its level prior to the treatment (p=0.8), but high positive correlation between decrease in hGh level and its initial value (R=0.75, p=0.002). Decreases in both somatomedin C (p=0.7) and hGH (p=0.6) levels were not correlated with patients' age. The therapeutic outcome defined as decrease in somatomedin C level was not significantly different between patients with or without adjunctive radiotherapy in the past (p=0.08) and between patients with intensive or weak isotope collection in the pituitary in 99mTc-octreotide scintiscan (p=0.2).Octreotide-LAR efficiently reduces somatomedin C and GH levels in patients with active acromegaly. Initial values of somatomedin C as well as age and isotopic imaging findings are not valuable predictor factors for therapeutic outcome.

Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.

Adrenal mass discovered during imaging for non-adrenal related causes is called incidentaloma. Adrenal masses can be asymptomatic or can have clinical manifestations related to hormone overproduction. The increasing number of discovered adrenal mass is by no doubt due to quick development of radiology procedures. The aim of study was determination of statistical frequency of different types of adrenal tumours and related clinical symptoms based on retrospective analysis of patients diagnosed in the Department of Endocrinology, Collegium Medicum, Jagiellonian University. There were 271 patients (184 female, 87 male) with incidentaloma confirmed in CT scan from January 2000 to June 2005. Mean patients' age was 56.8 +/- 12.7 years. The most common localisation was right adrenal gland (135 cases), bilaterally in 29 patients. Tumours less than 3 cm in diameter were observed in 58.5% of diagnosed persons, tumours from 3 to 6 cm in 33.3% of cases and tumours bigger than 6 cm in 8.2% patients. Hormone excess associated with adrenal mass was detected in 37 (13.6%) patients. Pheochromocytoma was diagnosed in 20 patients (7.4%). Subclinical hypercortisolism was found in 13 patients (4.8%). Primary hyperaldosteronism was diagnosed in 4 cases (1,4%). In patients with adrenal mass incidentaloma hormone tests should be performed before making therapeutic decisions despite no clinical symptoms.

Somatostatin receptor scintigraphy (SRS) has become a routine imaging method for the diagnostics of neuroendocrine tumours (NET). (99m)Tc-EDDA/HYNIC-octreotate (Polatom, Poland) is a new radiotracer with high affinity for SSTR2 and similar physiological biodistribution to (111)In-Octreoscan. We present a case of a 47-year-old man with disseminated duodenal carcinoid. The patient had been operated due to the tumour mass detected in pancreatic head area. Histopathology revealed carcinoid of the duodenal wall with local lymph node and liver metastases. The patient was qualified for chemotherapy stopped due to severe leucopenia. (99m)Tc EDDA/HYNIC-octreotate scintigraphy was performed for staging and to determine SSTR status of the tumour before planned 90Y-DOTATATE therapy. The multiple metastatic lesions were detected all over the body. The high quality images with high target/non target ratio were obtained. (99m)Tc-MDP scintigraphy confirmed multiple bone metastases. On the basis of SRS result the patient was qualified for 90Y-DOTA-TATE therapy. In conclusion, (99m)Tc EDDA/HYNIC-octreotate can be regarded as a promising tracer for staging and to determine SSTR status of NET.

In clinical studies insulin resistance, the main factor of the Metabolic Syndrome (MS), is determined directly by metabolic clamp technique, while in epidemiological studies is estimated on the basis of indices calculated from oral glucose tolerance test glycemia and insulinemia. The aim of the study was to find out which insulin resistance indicator best predicts the risk of the MS.The study population consisted of 2673 inhabitants of Kraków, aged 35-75 years, who participated in the "Polish Multicenter Study on Diabetes Epidemiology". Fasting insulin, HOMA-IR, QUICKI and Matsuda's index were determined for all subjects. Insulin resistance was defined as the cutoff values for the population with normal glucose tolerance and with BMI25 kg/m2.All insulin resistance indices were closely correlated (r=0.78-0.98), and the frequency of insulin resistance in the general population was similar (47%-54%), however the highest prevalence of insulin resistance was observed when Matsuda index was used. The risk of insulin resistance, increased with the category of glucose tolerance, and was the highest when Matsuda index was used. The MSWHO was observed in 42% to 45% of the studied population and the predictive value of insulin resistance indices were similar when using WHO criteria. The highest sensitivity in the MSNCEP identification was observed when Matsuda index was used. Matsuda index had also the highest sensitivity to diagnose MSNCEP as compared with the remaining insulin resistance indices.The study insulin resistance indices have a similar value in predicting the MSWHO while Matsuda index predicts best the MSNCEP. Matsuda index as well predicts best the risk of insulin resistance. This argues in favor of using oral glucose tolerance test to estimate risk for diabetes mellitus and cardiovascular disease.

Radioactive iodine (131I) is a well-established therapeutic modality in the treatment of toxic solitary autonomous thyroid nodules. This method is preferred in patients with small, benign nodules. The aim of our study was to investigate the effects of radioiodine therapy on thyroid size in patients with a solitary toxic thyroid nodule. 22 patients with single nodule in USG and confirmed "hot" nodule in scintigraphy were enrolled in the study. Thyroid and nodule volume were determined by ultrasound before, 3 and 6 months after the administration of 131I. Thyroid function was assessed by TSH level prior to the treatment and 6 weeks after the therapy. Thyroid volume and nodule size decreased significantly within 3 and 6 months after 131I treatment. The mean reduction of thyroid volume within 6 month after treatment was 32%. Reduction in thyroid volume and nodule, size was significantly greater within first 3 months than within next 3 months. Patients with smaller nodules (less than 70% of thyroid volume) were characterized by greater reduction of goiter size than patients with nodules bigger or equal to 70% of thyroid volume.

In this review article, the application of sentinel lymph node (SLN) lymphoscintigraphy not only in breast cancer and melanoma but also in cancers of the genital organs and the lungs is described. After a brief historical background, including Virchow and Cabanas' views, a description of the basic technique and the sensitivity and specificity of this technique in identifying SLN in breast cancer and melanoma are presented. In cervical and vulvar cancer and also in lung cancer, special techniques are applied before and during surgery and evaluated after surgical operation. The advantages and disadvantages of using SLN lymphoscintigraphy are described. Finally, our experience from using SLN lymphoscintigraphy, especially in cervical cancer, is presented. The technique for SLN mapping may save the patient from extended surgical procedures, indicate the pathways of lymph drainage and identify skip metastases. Nevertheless, the sensitivity of this technique should improve more in order to provide information concerning the extent of surgical treatment.

At all stages of the disease, serious difficulties are encountered in the imaging diagnosis of carcinoids. Somatostatin receptor scintigraphy (SRS) holds great promise for detecting primary tumours and metastases. 99mTc-EDDA/HYNIC-octreotate should significantly improve the diagnosis of carcinoids in comparison with 111In-Octreoscan owing to the better affinity for SSR2 and the higher count rate. The aim of this study was to assess the diagnostic efficiency of 99mTc-EDDA/HYNIC-octreotate scintigraphy in the detection and staging of carcinoid tumours.The study population comprised 75 patients (age 48.5+/-15.5 years): 46 with histological confirmation of carcinoid and 29 with suspected disease. 99mTc-EDDA/HYNIC-octreotate (740 MBq) SRS and CT were performed in all patients. Fifteen patients were examined with 111In-Octreoscan.High-quality 99mTc-EDDA/HYNIC-octreotate images were obtained in all cases, with maximum tumour tracer accumulation 4 h p.i. The mean target/non-target ratios for whole body (WB) and SPECT scans were, respectively, as follows: primary lesions: 4.5 and 10.2; metastases: liver, 3.1 and 12.3; abdominal focal lesions, 2.7 and 5.8; lung, 2.7 and 8.3; mediastinum, 3.4 and 7.6; bones, 6.8 and 19.0. 99mTc-EDDA/HYNIC-octreotate WB scans revealed more metastases than 111In-Octreoscan, with better individual separation. 99mTc-EDDA/HYNIC-octreotate SRS revealed new metastatic lesions in seven patients with confirmed carcinoid, and in four with dissemination the primary focus was found. Five patients qualified for radioguided surgery and 11 were referred to 90Y-DOTA-TATE therapy. The sensitivity of SRS in comparison with CT was higher for primary lesions and liver and abdominal lymph node metastases. In the subgroup of patients with suspected neuroendocrine tumours, two duodenal carcinoids, one thymic carcinoid and one ileal carcinoid were found.99mTc-EDDA/HYNIC-octreotate, with high imaging quality, is an excellent alternative to 111In-Octreoscan for staging of carcinoids, and it seems to be the method of choice for detection of the primary focus in patients with metastases from an unknown primary tumour.

There were 10 acutely CO poisoned study patients without CNS history (head traumas, epilepsy, dementia, migraine or alcoholic diseases) in whom (99m)Tc-HmPAO SPET, HMRS and neuropsychological testing were performed. 99mTc-HmPAO SPET and neuropsychological testing were performed twice: in acute phase and at six months post CO exposure. HMRS was carried out at 8 months post CO exposure. A multidimensional analysis of variance (MANOVA) was used to statistical analysis. Regional CBF disturbances in acute phase of CO poisoning were observed in frontal cortex, basal ganglia and parietal cortex respectively. The most reversible, as seen in control (99m)Tc-HmPAO SPET examination, were the changes observed in parietal cortex. Diffuse generalized cortex hypoperfusion, both in acute phase and at 6 months post exposure, was seen only in one the patient. In all of the examined patients different elevation in mobile lipid or/and lactate concentration in frontal lobe or/and basal ganglia was revealed by HMRS evaluation at eight months post acute CO exposure. Results of neuropsychological testing at baseline and at 6 months partially correlated with neuro-imagine techniques applied.

Myocarditis is most often caused by Coxackie B virus, influenza viruses, and echoviruses. It is usually self-restricting and ending in full recovery, but in some patients the infection leads to congestive cardiomyopathy. It is difficult to identify patients with myocarditis using clinical criteria, laboratory tests, ECG and ultrasonography, and currently a myocardial biopsy is required to establish the diagnosis. The risk of complications, sampling error and costs of this procedure underline the need of non-invasive but sensitive methods of imaging. Several radiopharmaceuticals have been used so far to confirm inflammation: 67Ga, (99m)Tc-nanocolloids and 111In-leucocytes. Scintigraphy with radiolabeled autologous white blood cells (WBCs) is considered a very useful method in identifying sources of inflammation but is difficult to perform and time-consuming.The aim of our study was to investigate whether scintigraphy with (99m)Tc-Anti-Granulocyte BW 250/183 antibody is a valuable diagnostic method in evaluating focal and diffuse inflammation of the heart and could therefore be suggested for use in screening for acute myocarditis.A two dimensional scintigraphy and SPECT mode of heart imaging with the use of (99m)Tc-Anti-Granulocyte antibody (740 MBq) was performed on 14 subjects (11 males and 3 females) aged 25-60 years with a positive myocardial biopsy confirming an inflammatory process in the myocardium. After i.v. administration of the tracer a 1 minute series of planar scans was performed within the first 60 minutes. Delayed static scans were performed at 1, 2, 4 and 24 hours.The scintigraphic scans revealed the uptake of the tracer in the heart area in 13 patients, confirming active inflammatory process. Follow-up scintigraphy was performed 3-5 months after the first study, when the control myocardial biopsy was negative. The results of the study showed the concordance between myocardial biopsy and scintigraphy results in patients with an inflammatory process in the heart.Scintigraphy with the use of (99m)Tc-Anti-Granulocyte seems to be a useful diagnostic method in evaluating patients with suspected myocarditis, but further studies are needed to establish its sensitivity and specificity.

The environmental iodine deficiency has been a serious problem in the Polish health care system for many years. In many European countries the prevention of iodine deficiency-related health deficits in population scale is based on edible salt supplementation with KI. In the decade of the 80-ties the iodine supplementation program in Poland was stopped, which has caused a subsequent increase in prevalence of goiter and iodine deficiency-related hypothyreosis. These diseases were observed in many regions of Poland, including the areas beyond regions of formerly known iodine deficiency endemias. In order to control the whole Polish population, iodine consumption deficit in1991 the "Polish Program of Iodine Deficiency Control and Prevention of Iodine Deficiency-related Disorders" has been established in the year 1991. In 1992--1996 a common iodine supplementation of salt used for general consumption was 20 mg KI/kg of NaCl, and in 1997 the mandatory supplementation of salt was 30 (+10) per kg of salt which has been introduced for the whole country. This paper reports the results of iodine excretion assays in school children 6-12 years old, in the years 1993--94, 1996--97 and 1999--2002 respectively. The obtained collections of iodine urine concentrations have shown distributions with a remarkable rightward skewness. Normalization of distributions required logarythmic transformation. The quartile values obtained for data collections from years 1992--94, 1996--97 and 1999--2002 have shown that in 5-7 years of iodine deficiency prevention program yielded increase in iodine excretion in morning urine samples by about 37.8 microg, while the iodine excretion median values increased from 63.5 mg/L in years 1992--1994 to 94.0 mg/L in years 1999--2001, respectively. The lower limits of iodine excretion ranges calculated as the mean value minus 2SD of transformed data for the years 1992--1994 amounted to: 7.74 mg/L and for the years 1999--2001 amounted to 14.1 microg/l, respectively. Assessing percent of children obtaining low iodine suplementation then recommended (below 50 mg/L in urine sample) amounted to 35.8% in years 1992--1994 and 15.4% in years 1999--2001 respectively.

Regardless the autoimmune origin of Graves' disease, the preferred method of its treatment remains antithyroid drug administration. Use of immunosuppressive agents (mostly steroids) is still limited to the therapy of disease complications, such as proliferative ophthalmopathy. The aim of the study was to assess the influence of early immunosuppressive treatment of autoimmune thyrotoxicosis with azathioprine on the course of the disease and the incidence of its complications. The study comprised 64 patients (47 females and 17 males aged 20-43 years) for the first time diagnosed with Graves' disease. The subjects were randomised into two groups. Group I consisted of 28 patients treated only with antithyroid drugs, the remaining 36 subjects additionally receiving azathioprine were included into group II. The dose of both drugs was adjusted during the treatment according to metabolic status of each patients. The treatment was continued for 8-14 months, the follow-up duration after therapy withdrawal was 5 years. Euthyreosis was achieved in all patients 2-8 weeks after treatment initiation. No drug intolerance symptoms were observed in group I. In four patients additionally treated with azathioprine, gastrointestinal side effects or leucopenia were present. The disease relapse was observed during the follow-up period in 15 (53.5%) patients of group I and in 3 (8.3%) of group II, the difference was statistically significant (p0.01). Only one patient receiving additionally azathioprine presented ophthalmic symptoms compared with seven subjects (25%) treated only with antithyroid drugs (p0.001). The patients of group I were also more frequently referred to surgical treatment due to rapid goitre growth (accordingly 5 (17.8%) and 1 (2.7%) patients, p=0.07), the difference between both groups not being statistically significant.Additional early immunosuppressive treatment significantly decreased frequency of Graves' disease complications and thyrotoxicosis recurrence. The use of azathioprine may be advised in patients with contraindications to the radical Graves' disease treatment and in prophylaxis of its complications.

As a somatic evaluation by outpatient psychotherapy service for alcoholics is being done very rarely the patients are not informed about health harm related to alcohol having the "false feeling of safety". The aim of the study was to evaluate a functional and morphological liver state of patients served by such a service for minimum 5 years who were sent do the Department of Clinical Toxicology via intervention medicine. The changes in the central nervous system were also considered. The West Haven criteria of altered mental state in hepatic encephalopathy were applied. The Number Connection Test, part A and B, and "100-7" test were used to psychometric evaluation. A significantly higher serum ammonia concentration (p0.02), AST, ALT and GTP enzymes activity, bilirubin (p0.02), iron (p=0.005) concentration and significantly lower prothrombin index and albumin concentration were found in the group of ethanol dependent patients as compared to the reference group. A significantly lower RBC and platelets number, lower Ht and significantly elevated MCV compared to the control group were also found. The relationship between West Haven criteria and results of laboratory testing was shown: a worse West Haven criteria a worse metabolic disorders. The pathologic changes in the liver ultrasonography and scintigraphy were significantly higher in the group of ethanol dependent patients. The presented observations indicate on necessity of close co-operation between psychologists, therapeutics and clinical toxicologists in early diagnosing and treatment the organ injury in alcohol addicted patients.

In our previous study a tetraethyl lead poisoning due to a rural environmental exposure of four family members was described. A differently intensified OUN dysfunction dominated clinical picture. Cognition status and degree of OUN dysfunction was monitored using generally accepted neurobehavioral test battery. The tests applied were fitted individually to each poisoned family member in accordance to current intensification of symptoms. Basing on the neurobehavioral performance results a consecutive imagine techniques were introduced to full CNS evaluation of intoxicated patients. Results of neuropsychological monitoring in 12 months period were compared to brain CT, SPET 99mTc-ECD used to evaluation of regional brain perfusion disturbances, MRI and MRS and presented in the study.

The double tracer (99mTc-MIBI and 99mTc-Amiscan) scintigraphy is an useful technique to imagine cardiac injury due to CO intoxication. Accumulation (retention) of 99mTc-MIBI is dependent on blood flow and cellular and mitochondrial electrical potential of myocytes. The lower tracer accumulation is seen not only in necrotic heart tissue regions, but also in ischemic area of worse metabolic rate and perfusion. 99mTc-Amiscan contrary to 99mTc-MIBI, is accumulated only in regions of early necrosis so it can be can distinguished from transitory ischemia. Mechanisms of cardiac injury due to CO toxicity is different than due to coronary occlusion and the process of the heart damage is usually much longer. Results of control stress-rest 99mTcMIBI scintigraphy, performed after 6 months from CO exposure in relation to the clinical state on admission and results of 99mTc-MIBI and 99mTc-Amiscans scans obtained in acute phase of poisoning are presented in the study. Initial 99mTc-MIBI SPET examination had confirmed transitory myocardial ischemia of different degree in all the examined patients. The mutual dependence between degree of scintigraphic changes and blood lactate level and CK activity was found. 99mTc-Amiscan scintigraphy demonstrated areas of necrosis in myocardium of some patients; they had statistically higher COHb and blood lactate concentration compared to the rest. A control stress-rest 99mTc-MIBI SPET performed 6 months after CO intoxication, confirmed a late consequences of metabolic abnormalities and a necessity of cardiovascular system follow-up controlling.

Carbon monoxide (CO) poisoning continues to be a significant health problem. An early assessment of organs injury due to carbon monoxide poisoning is even more difficult than confirming the diagnosis of CO poisoning. Numerous neuroimaging techniques have been used to evaluate CO intoxication. The aim of this pilot study was to estimate the regional cerebral perfusion in CO acutely poisoned patients using 99mTc-HmPAO SPET. Disturbances in cerebral perfusion mainly in frontal, parietal cortex and basal ganglia were observed in 17 (85%) of 20 examined CO poisoned patients. 99mTc-HmPAO scintigraphy seems be useful in demonstration of early CNS dysfunction and estimation to what extent perfusion abnormalities influence the brain injury. A further study to evaluate the rCBF in relation to poisoning severity scoring are needed.

Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to the hemodialysis mode of terminal renal failure treatment. Nutritional status impairment is common among patients with end-stage renal disease, and its laboratory surrogates predict increased morbidity and mortality risk in patients on chronic haemodialysis or peritoneal dialyses. The aetiology of malnutrition is multifactorial and delayed gastric emptying is also considered to be a significant factor. The aim of this study was to estimate the direct influence of indwelled dialysate in the peritoneal cavity on gastric emptying in patients treated with CAPD.the study group included 20 patients (9 males, 11 females) aged 50,1 +/- 11 years (range: 39-75 years) with chronic renal failure treated with CAPD for 18.4 +/- 14.7 months. All patients were non-diabetic and had no other than chronic uraemia co-morbidity known to influence autonomic nervous system function and gastric motility. The control group included 15 healthy volunteers matched by age, sex and body weight. Dialysis adequacy parameters were calculated based on 24-hour urine and dialysate collections. Gastric emptying was estimated with dynamic abdominal scintigraphy. We compared the results of gastric emptying tests performed in dialysed patients with and without dialysate liquid in the peritoneal cavity and related the values to those of the control subjects.In the study group, weekly values of dialysis parameters were within the ranges considered satisfactory in terms of uraemia control. All parameters of gastric emptying were significantly delayed and prolonged in terminal renal failure patients, but the results have shown no significant differences between those with and without indwelling dialysate.Based on the results we conclude that gastric emptying in subjects with chronic renal failure treated with CAPD is markedly delayed compared to healthy subjects. There was no significant effect of indwelling dialysate in the peritoneal cavity on gastric emptying rates found, based on the observation that its removal was not associated with any noticeable improvement of gastric emptying. The data strongly contraindicate the theory of peritoneal dialysate volume being the cause of this reversible disorder and indicate that the role of other possible factors leading to the development of gastropathy in those patients should be investigated.

Postprandial hypotension is commonly defined as the decrease in systolic blood pressure of 20 mm Hg and more, observed within 2 hours after meal ingestion. This phenomenon was described in subjects with comprised function of autonomic nervous system. However, the data on its prevalence in diabetic patients are scarce. The aim of the study was to assess the concordance of postprandial hypotension and autonomic cardiovascular neuropathy in diabetes mellitus. The study included 67 patients (26 males, 41 females, mean age: 47.5 +/- 16.2 years) with diabetes type 1 or 2 (mean disease duration: 13.3 +/- 8.8 years), treated with diet and insulin injections. Postprandial hypotension was diagnosed based on results of automatic blood pressure recordings performed within 90 minutes after test meal ingestion. Tests of Ewing's battery were used to evaluate autonomic cardiovascular neuropathy.Mean postprandial decrease in systolic blood pressure of 17.7 +/- 11.7 mm Hg was noted at 48.0 +/- 13.7 min after meal ingestion. The study patients were divided into 2 groups based on results of systolic blood pressure recordings. In group A of 39 subjects (58.2%) the mean fall in systolic blood pressure of 8.9 +/- 4.4 mm Hg was observed. In group B of 28 (41.8%) subjects fulfilling the criteria of postprandial hypotension systolic blood pressure decreased after the meal of 30.0 +/- 6.2 mm Hg, the difference between groups was statistically significant (p0.001). Autonomic cardiovascular neuropathy was recognized in 41 (61.2%) of the study patients. The more advanced neuropathy was stated in group B (neuropathy scale score: group A--1.54 +/- 1.48 points, group B--5.11 +/- 1.93 points, p0.001). Statistically significant correlation between the magnitude of postprandial systolic blood pressure fall and cardiovascular neuropathy scale score was noted (Spearman's correlation co-efficient R: -0.612: p0.01). Postprandial blood pressure fall correlated significantly with orthostatic systolic blood pressure changes (correlation co-efficient R: 0.610; p0.001).Postprandial hypotension is an important symptom of diabetic cardiovascular neuropathy. It is recommended to include postprandial blood pressure measurements in diagnostic algorithm of autonomic nervous system dysfunction in diabetic patients.

The thyroid fine-needle aspiration (FNA) is the decisive examination in the preoperative diagnostics of thyroid nodules. Different cytohistologic studies have revealed that the accuracy of FNA for thyroid nodules varied from 69% to 94%. The aim of our study was to compare the results of FNA with regard to final histopathological diagnosis among patients with follicular tumor, Hurthle cell tumor or papillary carcinoma in FNA. We retrospectively analyzed medical documentation of 51 patients (mean age 57.9 years, 49 women and 2 men) from the Endocrinology Department from 1997 to 2002 years. Based on FNA 29 patients were diagnosed as having follicular tumor, 10 as having Hurthle cell tumor and 12 as having papillary carcinoma. Carcinoma was detected histopathologically in 38% of patients with follicular tumor. Follicular carcinoma was detected histopathologically in 10% of patients with Hurthle cell tumor. Cytological diagnosis was confirmed histopathologically in 66.8% of all patients with papillary carcinoma in FNA. In accordance with our results the confirmation of malignant neoplasm can be expected in more than 80% of cases with papillary carcinoma in cytological examination. In case of follicular or Hurthle cell tumors the frequency of malignant neoplasm was less than 40% and 10% respectively.

Protein losing enteropathy (PLE) is a gastrointestinal disorder that is associated with excessive loss of plasma protein into the gut resulting from abnormal mucosal permeability. The disease is usually caused by inflammation. The loss of protein in PLE is a nonselective process affecting albumin, globulin and transferrin. Abdominal scintigraphy with human serum albumin marked by Tc99m seems to be an easy and sensitive method for diagnosing PLE. An 4-year-old girl was presented to an outside Pediatric Department due to hypoproteinemia and recurrent pneumonia which had caused several prior hospitalizations. The laboratory tests revealed hypoproteinemia, hypoalbuminemia, low level of IgG, sideropenia, and a decreased level of T lymphocytes. The loss of protein into the gut was confirmed by fecal clearance of alfa-1 antitrypsin. Only nonspecific inflammation was detected by biopsy of the small intestine. These clinical and laboratory findings, quickly decreasing IgG and albumin levels in spite of i.v. supplementation and the lack of proteinuria permitted PLE diagnosis. The abdominal scintigraphy was planned to assess and localise protein losing through GIT and for strategy of possible surgical treatment. Abdominal dynamic scintigraphy was performed immediately after the injection of 300 MBq Tc99m human albumin. 90 images were taken within 180 minutes. Delayed abdominal images were obtained 6 and 24 hours after the tracer injection. Anterior abdominal scintigraphy showed pathological activity of Tc99m-albumin in small bowel in the upper left segment of the abdomen in the 40th minute after injection. Extensive accumulation of albumin was seen in the 160th minute. Delayed images, after 3 and 6 hours, revealed translocation of the tracer into the lower right abdominal segment. The further passage and tracer concentration was detected in ascendant and transverse colon. Based on the laboratory tests and scintigraphic images the girl was suspected to have segmental lymphangiectasia of small intestine and was qualified for laparatomy and, possibly, for surgical resection of the pathologically changed bowel. However, diffuse pathological changes revealed in the guts during the operation, rendered the operation impossible. Tc99m-labelled human serum albumin scintigraphy may be considered the method-of-choice in the diagnosis of protein-losing enteropathy. However, in this test the assessment of the enteropathy dimension is difficult and surgical treatment should be planned with caution.