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Neutrophils release neutrophil extracellular traps (NETs) as a defense strategy in response to broad-spectrum infections and sterile triggers. NETs consist of a DNA scaffold decorated with antimicrobial peptides (AMPs) and enzymatically active proteases, including peptidyl arginine deiminase type 4 (PAD4). Susceptibility to infections and inflammatory dysregulation are hallmarks of alcohol-related liver disease (ALD). Sixty-two patients with ALD were prospectively recruited, and they were followed for 90 days. Twenty-four healthy volunteers served as the control group. PAD4 concentrations were quantified using immunoenzymatic ELISAs. Correlation coefficients between PAD4 blood concentrations and markers of systemic inflammation; liver dysfunction severity scores; and ALD complications were calculated. The receiver operating curves (ROCs) and their areas under the curve (AUCs) were checked in order to assess the accuracy of PAD4 expression in predicting the degree of liver failure and the development of ALD complications. Systemic concentrations of PAD4 were significantly increased in the patients with ALD in comparison with controls. PAD4 levels correlated with the standard markers of inflammation and revealed a good predictive AUC (0.76) for survival in the whole ALD group. PAD4 seems to be an inflammatory mediator and may be potentially applied as a predictor of patient survival in ALD. [ABSTRACT FROM AUTHOR]

Various laboratory parameters are commonly used to assess the efficacy of biological treatment (BT). The aim of our study was to assess the correlation between platelet (PLT) indices: (mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW)), C-reactive protein (CRP) and endoscopic picture in the course of infliximab induction regimen in ulcerative colitis (UC) patients. The study enrolled 46 patients with UC – 32 men and 16 women. They were administered infliximab (standard induction therapy). Laboratory tests (CRP and PLT indices) and colonoscopy were performed in all patients during the induction regimen – at 0, 2, and 6 weeks and in follow-up six weeks after the completion of induction therapy. The study revealed a statistically significant decrease in CRP and PLT, and an increase in MPV, together with improvement of endoscopic picture (p

Various laboratory parameters are commonly used to assess the efficacy of biological treatment (BT). The aim of our study was to assess the correlation between platelet (PLT) indices: (mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW)), C-reactive protein (CRP) and endoscopic picture in the course of infliximab induction regimen in ulcerative colitis (UC) patients. The study enrolled 46 patients with UC -- 32 men and 16 women. They were administered infliximab (standard induction therapy). Laboratory tests (CRP and PLT indices) and colonoscopy were performed in all patients during the induction regimen -- at 0, 2, and 6 weeks and in follow-up six weeks after the completion of induction therapy. The study revealed a statistically significant decrease in CRP and PLT, and an increase in MPV, together with improvement of endoscopic picture (p <0.001) (MAYO score, MAYO endoscopic subscore) in all patients. PCT and PDW values remained in normal ranges before BT and after the finish of the induction regimen. PCT correlated positively with CRP before the introduction of BT (p = 0.018). In addition, positive correlations between PCT and PLT count were noticed before infliximab induction regimen and in follow-up after the finished of therapy (p <0.001). Additionally, a negative correlation between PLT count and MPV prior to the first dose of infliximab was observed (p=0.032). Our data suggest that PLT indices could be useful biomarkers for determining active UC and for assessing the efficacy of BT. From what we know, this is the first survey devoted to PLT parameters in Polish patients with UC. [ABSTRACT FROM AUTHOR]

Melatonin and -tryptophan (Trp) are highly gastroprotective in humans, but no study has assessed their impact on healing of chronic gastroduodenal ulcers in humans. Three groups (A, B and C) of 14 idiopathic patients in each treatment group with gastroduodenal chronic ulcers were treated with omeprazole (20 mg twice daily) combined either with placebo (group A), melatonin (group B) or with Trp (group C). The rate of ulcer healing was determined by gastroduodenoscopy at day 0, 7, 14 and 21 after initiation of therapy. Plasma melatonin, gastrin, ghrelin and leptin were measured by RIA. On day 7, omeprazole by itself (group A) had not healed any ulcers, but four ulcers were healed with omeprazole plus melatonin and two with omeprazole plus tryptophan. At day 21, all ulcers were healed in patients treated with melatonin or Trp, but only 10-12 ulcers were healed in placebo-treated patients. After treatment with omeprazole plus melatonin (group B) or Trp (group C), plasma melatonin levels rose several-fold above initial values. Plasma gastrin level also rose significantly during treatment with omeprazole plus melatonin or Trp, but it was also significantly increased in patients treated with omeprazole plus placebo. Plasma ghrelin levels did not change significantly after treatment with melatonin or Trp, while plasma leptin increased significantly in patients treated with melatonin or Trp but not with placebo. We conclude that melatonin or Trp, when added to omeprazole treatment, accelerates ulcer healing and this likely depends mainly upon the significant increments in plasma melatonin. [ABSTRACT FROM AUTHOR]

Hemochromatosis (HC) is the main genetic disorder of iron overload and is regarded as metal-related human toxicosis. HC may result from HFE and rare non- HFE gene mutations, causing hepcidin deficiency or, sporadically, hepcidin resistance. This review focuses on HFE -related HC. The illness presents a strong biochemical penetrance, but its prevalence is low. Unfortunately, the majority of patients with HC remain undiagnosed at their disease-curable stage. The main aim of HC management is to prevent iron overload in its early phase and remove excess iron from the body by phlebotomy in its late stage. Raising global awareness of HC among health staff, teaching them how not to overlook early HC manifestations, and paying attention to careful patient monitoring remain critical management strategies for preventing treatment delays, upgrading its efficacy, and improving patient prognosis.

Unlabelled: Iron is an essential micronutrient of almost all organisms, which is involved in many metabolic processes. Disorders of serum iron balance that relate mainly to its deficiency are frequently observed in patients with liver diseases. The aim of the study was the evaluation of serum iron parameters in patients with different chronic liver diseases and analysis of the relationships between serum level of iron, ferritin and transferrin in women and men in groups examined., Material and Methods: The study includes 424 patients: 151 with alcoholic liver cirrhosis (ALC), 53 with nonalcoholic fatty liver disease (NAFLD), 54 with autoimmune hepatitis (AIH), 19 patients with hepatocellulare cancer (HOC), 34 with primary biliaris cirrhosis (PBC), 39 with chronic HCV hepatitis, 48 with chronic HBV hepatitis, 15 with primary sclerosans cholangitis (PSC) and 11 patients with hemochromatosis. Forty two healthy volunteers were the control group., Results: The highest mean serum level of iron was observed in patients with hemochromatosis and was 278.56 +/- 25.04 mg/dl. The mean level of iron was statistically significant different in patients with HCC in comparison to the patients with ALC (p = 0.0000), with AIH (p = 0.0108) and NAFLD (p = 0.00768). The mean level of ferritin was statistically significantly higher among patients with hemochromatosis (p = 0.0000), with ALC (p = 0.0037) and NAFLD (p = 0.0442) than in the controls. Patients with AIH, HCC, HCV infection, PSC and hemochromatosis showed higher serum level of transferin than the controls (p = 0.0000). The mean level of iron and ferritin was lowerin women than in men in the patients with ALC (p = 0.0088, p = 0.0018 respectively). The mean level of ferritin was significantly lower in men than in women among patients with NAFLD. (p = 0.0065). There were no statistically significant differences in the mean level of examined parameters between the sexes., Conclusion: Reduced serum level of iron is observed in chronic liver diseases. Elevated ferritin level is typical for patients with ALC and NAFLD. Differences in the level of iron, ferritin and transferin between men and women concemrn the patients with ALC while among patients with NAFLD only ferritin level differences are found.

Unlabelled: Alpha-fetoprotein (AFP) is a tumor marker used in clinical diagnosis and for monitoring the course of treatment. Serum concentration of AFP in excess of several hundred ng/ml is nearly 100 percent positive predictive value for hepatocellular carcinoma. The aim of this study was evaluation of AFP serum concentration in patients with different chronic liver diseases and the relationship between the concentration of AFP and gender in the studied groups of patients., Material and Methods: The study includes 359 patients: 72 with autoimmune hepatitis, 27 with cancer metastatic to the liver, 53 with nonalcoholic fatty liver disease, 207 with liver cirrhosis and 40 healthy volunteers as control group. The concentration of AFP was examined in all patients., Results: The highest AFP concentration occurred in the patients with autoimmune hepatitis, with metastatic liver cancer and with liver cirrhosis 16.81 +/- 5.49 ng/ml, 9.67 +/- 1.48 ng/ml i 8.42 +/- 2.73 ng/ml (p < 0.001 compared to the control group) respectively. Considering the classification of cirrhosis according to Child-Pugh Score the mean concentrations of AFP were: in Class A - 7.03 +/- 2.29 ng/ml, B - 7.59 +/- 2.45 ng/ml i C - 10.02 +/- 2.40 ng/ml. There were no statistically significant differences in the mean AFP concentrations between the patients with nonalcoholic fatty liver disease and the control group. Also showed no differences in the average concentration of AFP in men and women in study groups of patients (p > 0.05)., Conclusions: Elevated serum AFP concentration typically up to several ng/ml is observed in autoimmune hepatitis, metastatic liver cancer and liver cirrhosis. Concentration of AFP correlates with the severity of liver cirrhosis. Simple steatosis of liver as one of the forms of nonalcoholic fatty liver disease is characterized by normal serum concentration of AFP. No relationship between AFP concentration and gender in patients with chronic liver disease is observed.

The presence of ascites is usually associated with portal hypertension, usually due to cirrhosis of the liver, with portal vein thrombosis, congestive cardiac failure, nephrotic syndrome, pancreatitis, tuberculosis. Approximately 10% of all cases of ascites occurs in malignant tumors, mostly of ovarian cancer. The purpose of this publication is to present the case of 63-year-old woman who has a basic and initial sole manifestation of disease--cancer of the ovary--was increasing ascites.

Background: This study sought to define the mechanism by which PPAR-γ ligands affect the course of experimentally induced colitis in rats., Material/methods: Inflammation was induced in Wistar rats by a single rectal administration of 2,4,6,-trinitrobenzene sulfonic acid (TNBS). The antagonist of PPARγ antagonist, bisphenol A diglycidyl ether (BADGE), was administrated intraperitoneally 120 mg/kg 4 times every other day. Rosiglitazone 8 mg/kg was administrated by gastric tube 4 times. Body weight was measured daily. After killing, the large intestinal tissue was weighed and collected for histopathologic and immunoenzymatic tests. Levels of IL-6, IL-10, and myeloperoxidase (MPO) were determined in serum and in intestinal homogenates., Results: Rats receiving rosiglitazone had higher body weight, whereas large intestine weight/length ratio was lower; histology showed fewer inflammatory markers. Rats receiving TNBS and TNBS along with BADGE had more intensive inflammatory changes. Rosiglitazone alone decreased expression of IL-6; used with TNBS it decreased expression of MPO in intestinal tissue, yet did not increase the expression of IL-10. Decreased levels of MPO indicate reduced neutrophil-dependent immune response. The antagonist of PPAR-γ increased IL-6 in serum and decreased IL-10 in intestinal homogenates. Bisphenol A diglycidyl ether administrated to healthy animals increases serum IL-6 levels., Conclusions: Rosiglitazone inhibits experimental inflammation; administration of its selective antagonist abolishes this protective influence. Rosiglitazone inhibits expression of proinflammatory IL-6 and does not affect IL-10. Agonists of PPARs-γ are possibilities for inflammatory bowel disease prevention. Exogenous substances blocking PPARs-γ may contribute to development or relapse of nonspecific inflammatory bowel diseases.

Liver diseases in pregnancy constitute substantial clinical problem. Liver diseases occurring only during pregnancy, include: intrahepatic cholestasis of pregnancy acute fatty liver of pregnancy HELLP syndrome, pre-eclampsia and eclampsia. They can be associated with significant maternal and fetal morbidity and mortality The following article explores the pathogenesis, the clinical features, risk factors and management of above listed disorders. Early diagnosis and immediate decisions are essential for maternal and fetal survival.

Background: The purpose of this experiment was to investigate the role of PPAR ligands in the course of inflammation and of rosiglitazone, a PPAR-gamma-specific agonist, on the course of experimental acute pancreatitis (EAP)., Material/methods: EAP was induced by administration of 5% sodium taurocholate injected into the pancreatic duct. The inflammatory activity was evaluated by biochemical scores (alpha-amylase, lipase, aminotransferases, and bilirubin), morphological changes (determined by light microscopy, H+E stained), and immunohistochemical reactions (ICAM, nitrotyrosine)., Results: Rosilgitazone administered in the course of EAP at a dose 50 mg/kg p.o. decreased the intensity of morphological changes (edema, inflammatory infiltrates, necrosis, and erythrocyte extravasations). In the rosiglitazone-treated animals all the biochemical parameters of EAP were statistically significantly decreased. Immunohistochemical reactions against ICAM-1 and nitrotyrosine showed that rosiglitazone decreased the intensity of inflammatory reactions in the groups of treated animals., Conclusions: PPAR-gamma agonists modulate the course of the inflammatory reaction. The administration of rosiglitazone decreased the intensity of the inflammatory process in the course of sodium taurocholate-induced EAP.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. They originate from the myenteric ganglion cells, termed the interstitial Cajal cells. The majority, i.e. 95% of GIST, show expression of the membrane receptor protein CD117 with a tyrosine kinase activity c-kit. Gastrointestinal stromal tumors constitute less than 1% of all digestive tract tumors. They may be benign or malignant (30%), and occur in every part of the gastrointestinal tract, however the stomach is the most common localization. They develop with the same prevalence in men and in women, usually above the age of 50 years. The peak incidence is observed between the fifth and the sixth decade of life. Symptoms are not typical and depend on the localization and the tumor size. About 10-30% of GIST are completely asymptomatic, and are discovered accidentally during the endoscopy or X-rays evaluation as well as during surgical interventions performed for various reasons. The malignant tumors metastasize most commonly to the liver and peritoneum. The metastases are rarely found in the lungs, pleura and bones. The detection of GIST is based on imaging, endoscopy, histological and immunohistochemical examinations. A useful and promising diagnostic procedure is positron emission tomography. The final diagnosis is mostly based on the pathologic findings of the removed tumor. The prognosis of GIST depends on its size, mitotic activity in 50 high power fields and mucosal infiltration. Radical surgery is the best treatment of GIST.

Colorectal cancer (CRC) is one of the most frequent malignancies in Western countries. The lifetime risk of developing CRC is estimated at 5-6%. Available data indicate that the epidemiologic situation in Poland leaves a lot to be desired. Approximately 8000 patients die of CRC each year in Poland and outcomes of the disease treatment expressed as the 5-year survival rate are among the worst in Europe, not exceeding 25%. Colorectal cancer is a disease which requires activities promoting early diagnostics and wide-scale prevention due to the fact that it meets the pathologic criteria suitable for the population screening tests. Different screening tests are used in routine medical practice and their use depends on their availability to a patient, according to the principle of superiority of any screening over no screening. This article reviews different screening methods according to their practical value assessed on the basis of the best available evidence.

Aim: To find the ADH3 genotypes in the Polish population likely to be responsible for higher susceptibility to alcohol disease of the liver and chronic alcohol pancreatitis., Method: The ADH3 genotype and ADH3*1 and ADH3*2 alleles frequencies were examined in 198 patients. Genotyping of the ADH3 was performed using PCR-restriction fragment length polymorphism methods on a white cell DNA., Results: The genotype ADH3*1/ADH3*1 was found to be significantly more frequent in alcohol abusers compared with non-drinkers. The examinations of the group of alcohol abusers showed that the genotype ADH3*2/ADH3*2 occurred statistically significantly less frequently in patients with chronic pancreatitis than in those without alimentary lesions (healthy drinkers). The alleles ADH3*1 and genotype ADH3*1/ADH3*1 were significantly more frequent in men than in women, whereas alleles ADH3*2 and genotype ADH3*2/ADH3*2 were more common in women., Conclusions: The genotype ADH3*2/ADH3*2 is likely to be a protective factor for chronic pancreatitis. Variations in ADH3 genotypes may account for some of the differences in prevalence of alcohol dependence between genders in the Polish population.

The aim of the study was to analyse the prevalence of H. pylori infection in adult inhabitants of Lublin Province. The effects of living conditions and lifestyle on the infection frequency were evaluated. The study included 585 adults randomly chosen for the epidemiological analysis of H. pylori infection in the Lublin region within the project commissioned by the Ministry of Health (PCZ 08-09) and State Committee for Scientific Research (C007/P05/2000). The study was based on a personal questionnaire and determinations of anti/Hp antibodies in IgG class using the ELISA method. High titres of anti/Hp antibodies (> 24 IU/ml) were demonstrated in 78.5 % of the subjects. In Lublin Province the infected individuals constitute 72 % of inhabitants, in the big towns--74 % and in small towns--95 %. According to the place of birth: among those born in the country 87 % are infected, compared to 78.4 % in the small towns and 64 % in the big towns, respectively. Positive test results were observed in 79 % of farmers, 78 % of manual workers and 75 % of mental workers. The percentage of the affected neglecting basic hygienic rules exceeded 90 %. With increased frequency of hygienic measures the number of the H. pylori infected individuals decreased to 65 %. The prevalence of H. pylori infection among the inhabitants of the Lublin region is lower than that found in town inhabitants. Lublin Province shows the lowest level of H. pylori infection in Poland. The H. pylori infection is strongly affected by the lack of basic rules of personal hygiene and improper diet.

Unlabelled: Alcoholism is a significant medical, social, and economic problem. Genetic polymorphism of enzymes involved in alcohol metabolism plays a relevant role in etiopathogenesis of alcohol disease and alcohol liver cirrhosis. The aim of the study was the evaluation of the influence of genetic polymorphism of CYP2E1 on the development of the alcohol abuse and alcohol liver cirrhosis the Polish population., Material and Methods: The CYP2E1 genotype and c1 and c2 alleles frequency were examined in 188 patients. Genotyping of the CYP2E1 was performed using polymerase chain reaction-restriction fragment length polymorphism method on white cell DNA., Results: In the examined population encompassing 188 subjects the c2 allele was present only in 1.06% of patients. It was found only in patients abusing alcohol. In the group of patients with alcoholic cirrhosis it was present in 3.5% of cases. The c1/c2 genotype was present in 2.12% of subjects. The c2/c2 genotype was not found in any patient. Heterozygotes cl/c2 were present only in 7% of patients with alcohol liver cirrhosis. The c2 allele and cl/c2 genotype occurred statistically significantly more frequently in patients with alcohol cirrhosis than in control group. Patients possessing the c2 allele and cl/c2 genotype statistically significantly earlier initiated the alcohol abusing than those in which the c1 allele and c1/c1 genotype were present., Conclusion: Our studies suggest that the frequency of allele c2 in Polish population is low, but the presence of c2 allele may be a risk factor for the alcohol liver cirrhosis.

Congenital nonhemolytic hyperbilirubinemias (CNH) are quite rare pathology of liver. They occur most often in children, but are common in adults too. A common feature of congenital nonhemolytic hyperbilirubinemias is an abnormal serum bilirubin level without other abnormalities in routine liver functional tests. Liver histology on light microscopy is normal. Hereditary genetics defect of enzymes taking part in metabolism of bilirubin is the cause of CNH. They are divided into two groups: with unconjugated hyperbilirubinemia (Crigler-Najjar syndrome, Gilbert syndrome) and conjugated hyperbilirubinemia (Dubin-Johnson syndrome and Rotor syndrome). Because CNH in adults are benign disorders and the prognosis is excellent, patients do not require any specific therapy. Is important to take the differential diagnosis. Once the diagnosis of congenital nonhemolytic hyperbilirubinemia is confirmed, patients should be informed of the disease process and its benign nature to prevent needless work-up in the future. In present, CNH are treated as cosmetic defects and no therapy is applied.