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Aortic valve stenosis (AVS) and atherosclerosis can be regarded as two manifestations of the same pathological process. The study aim was to evaluate annually the plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha) in AVS patients, and to compare these data in AVS patients with and without high IgG, IgM, and IgA titers against Chlamydia pneumoniae.Sixty patients with AVS who had declined the offer of remedial surgery were allocated to groups according to their antibody titers: group A (n=30, high IgG titer), group B (n=30, low IgG titer), group C (n=22, high IgA titer), group D (n=38, low IgA titer), group E (n=7, high IgM titer), and group F (n=53, low IgM titer) Antibody titers, serum levels of inflammatory markers and echocardiographic scans were monitored at 12-month intervals.During a one-year observation period, a greater number of patients in group A showed AVS deterioration compared to group B (p0.02). The mean IgA and IgM titers in group A were higher than in group B, while mean serum CRP and IL-6 levels, and IgG titer, tended to be higher in group C compared to group D. No statistically significant differences were identified in mean serum levels of CRP, IL-6, and TNFalpha between groups A and B.The results of the study suggested a possible association between C. pneumoniae infection and the progression of AVS.

The authors presented coeliac disease diagnostic and treatment methods and its links with infertility. The hormonal disturbances in women with coelic disease were also shown. Perinatal complications in pregnant women with the disease were presented. The need for involvement of coelic disease into differential diagnosis algorythm were given.

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

OBJECTIVES: It is generally accepted that in adult type 1 diabetes patients (T1D) continuous subcutaneous insulin infusion (CSII) via a personal pump is more effective than the multiple daily injections (MDI) model. However, it is not clear whether all age groups of adult T1D patients may equally benefit from CSII therapy. We aimed to compare the glycemic control and use of selected pump tools in T1D subjects using CSII over the age of 50 (50+ T1D) with patients younger than 50 years of age. METHODS: The last available insulin pump/blood glucose meter downloads and last available HbA1c levels of 124 adult T1D subjects using CSII were reviewed. We divided our cohort into two subgroups: 50+ T1D patients (n = 13) and younger patients (n = 111). RESULTS: There were no differences in glycemic control achieved with CSII treatment in 50+ T1D patients vs. younger subjects. HbA1c levels were 7.01 ± 0.67% and 7.34 ± 1.24% (p = 0.46), and the mean glycemia based on glucometer downloads was 141.8 ± 17.7 mg/dl and 150.8 ± 35.7 mg/dl (p = 0.69), respectively. Also, there were no differences with respect to the use of important personal pump options and tools. CONCLUSION: In conclusion, insulin pump therapy appears to be effective and safe in T1D patients regardless of age.

The aim of this study was to assess attendance at the universal screening programme for thyroid function in pregnancy and attempt to evaluate the influence of age, number of past pregnancies, level of education, and place of residence on the attendance. The study was performed by means of a questionnaire.Our study was performed on the basis of an anonymous questionnaire handed out to 543 women aged 16-45 years, on the third day of their puerperal stay in one of five obstetric wards in southern Poland. The questionnaire contained questions about participation in plasma level measurements of TSH, fT4, total T4, thyroid antibodies or thyroid ultrasound scanning at least once in pregnancy.The rate of attendance at any examination of thyroid function among pregnant women was 26.7%. The highest attendance rate (32.7%) was found among women living in provincial capitals or with higher education (41.3%), whereas the lowest was among women who had completed only primary school (11%) and those living in county towns (15%). The number of previous pregnancies did not influence the thyroid screening attendance. Women over 21 years of age participated in this screening programme more frequently (27.1-30%).Less than one third of pregnant women participated in the thyroid function screening. Place of living, education level, and age were the main factors influencing the attendance rate.

There are discordant opinions about the influence of subclinical hypothyroidism to the fertility of the women. No unequivocal opinion has been presented concerning the purposefulness of the diagnostics process and treatment of the pregnant women with subclinical hypothyroidism. Few clinical studies suggest that there is a connection between thyroid antibodies and infertility, spontaneous miscarriages, implantation failures and fetal malformations.

The aim of this study was to evaluate the number of women who take multivitamin formulations containing iodine.A 34-question questionnaire was given to 500 women during their puerperal stay in two obstetrics/gynaecology wards in Krakow.295 pregnant women (59%) took iodine-containing formulations. 205 pregnant women (41%) took multivitamin preparations without iodine. 49.7% of the women (91 out of 183) who inhabited rural areas and small towns were not supplemented with iodine during pregnancy. Women in Krakow took iodine-containing multivitamin formulations in 61.2% of cases. Women with primary and secondary education did not use iodine supplementation in 48.3% and 50.3% of cases respectively. Women with a university education did not use supplementation in 38.6% of cases. The prevalence of women using iodine-containing multivitamin preparation was similar in each age group.The promotion of iodine supplementation to pregnant women should be augmented at each level of contact with medical staff. Medical staff should be reminded about such promotion at each level of medical care and training (general practitioner, obstetrics/gynaecology specialist, endocrinologist, postgraduate training).

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

Comparison of echocardiographic findings in AVS patients with and without high IgG, IgM, IgA titers against Chlamydia pneumoniae during 12 months' observation of AVS natural course.60 AVS patients who did not agree for operational treatment were divided into group A (30 patients with high IgG titer) group B (30 patients with low IgG titer), group C (22 patients with high IgA titer) group D (38 patients with low IgA titer), group E (7 patients with high IgM titer), group F (53 patients with low IgA titer) Antibodies titers and echocardiographic scans were carried out every 12 months.There were more (p0.02) patients with AVS deterioration in group A compared to group B. Group A patients had lower left ventricle posteriori wall systolic diameter compared to group B. There were no differences in echocardiographic parameters between group C and D. Mean ejection fraction was lower and mean right atrium diameter was higher in group E compared to group F.The results may suggest link between Chlamydia pneumoniae and deterioration of AVS.

To compare the influence of low and normal endogenous estradiol concentration on circulating hGH, IGF-I and IGFBP-3 levels as well as on mutual correlations of these parameters.45 women (age 30.7 ± 9.0 years, BMI 25.7 ± 8.0) divided into group A - 15 hypoestrogenic women and group B - 30 normoestrogenic controls. Neither of the women was menopausal nor hyperprolactinemic.Blood sample was taken at the standard conditions prior to the initiation of hormonal supplementation therapy in group A and at the day 3-5 of menstrual cycle in group B. Serum hGH, IGF-I, IGFBP-3, insulin, testosterone, sex hormone binding globulin (SHBG) dihydroepiandrosterone sulphate (DHEAS) and LH as well as prolactin (PRL), FSH and estradiol levels were measured by standard RIA kits.Mean IGF-1, LH, FSH, testosterone and estradiol and PRL plasma levels were lower in group A compared to group B. There were no significant differences in mean SHBG, insulin and DHEAS levels. There were also no differences in mean: age, body mass, BMI as well as percentage of each BMI range between groups. Regardless the estradiol level the IGF-I/age link was found in both groups. A IGF-I/IGFBP-3 relation was found in both groups. IGF-I/estradiol link was seen only in group A. In group B hGH/SHBG link was found, in group A this relation was indirect. A link between hGH and testosterone levels was found only in group B. SHBG was related in group B to IGFBP-3, testosterone and to DHEAS. Insulin/IGFBP-3 link was seen in group B. The stepwise multiple regression revealed DHEAS and LH as predictors of IGF-I level in group A, while in group B none of the parameters predicted IGF-I level. The results of the same analysis in case of hGH are as follows: in group A hGH level was predicted by estradiol and SHBG. In group B none of factors predicted hGH levels.Estradiol plasma level is correlated to circulating IGF-I, albeit the relation seems to be biphasic.

The structure and turnover of polichlorinated biphenyls (PCB) in environment was presented. The PCB absorption and metabolism in organisms as well as the PCB induced disruption of placental and ovarian steroidogenesis were discussed.

The 12 months' observation of body mass index (BMI) influence on natural course of aortic valve stenosis (AVS).60 AVS patients who did not agree for operational treatment were divided into group A (n = 15) with BMI 20-25, group B (n = 27) with BMI 25,01-30 and group C BMI30.Plasma Lp(a), total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-alpha) as well as titers of immunoglobulin (Ig) class G, A, M against chlamydia pneumoniae were measured every 12 months. Echo-cardiographic evaluation of aortic valve was also done every 12 months.Means serum CRP at 12 month was the highest in group C. No differences in mean serum TNF-alpha and IL-6 levels as well as in Ig titers between groups A, B, C were found. At 12 month of observation HDL/total cholesterol ratio as well as HDL/LDL-cholesterol ratio were the lowest in group B. Left atrium diameter and right ventricle diameter were bigger in groups B and C compared to group A at the visit I and after 12 months of observation. Systolic intraventricular septum (IVS syst) thickness was the highest in group C at visit I. Diastolic left ventricle posterior wall thickness (LVPW) was the highest in group C during 12 months of observation.The increase in fat tissue mass may lead to increase in inflammatory process and cardiac muscle remodeling in AVS patients.

Background Approximately 20% of children and adolescents in Europe are overweight. Survivors of pediatric acute lymphoblastic leukemia (ALL) are at increased risk of overweight and obesity. The purpose of this study was to assess leptin and leptin soluble receptor levels, as well as polymorphisms of selected genes in survivors of pediatric ALL, and the influence of chemo- and radiotherapy on development of overweight in the context of leptin regulation. Methods Eighty two patients (55% males), of median age 13.2 years (m: 4.8 years; M: 26.2 years) were included in the study. The ALL therapy was conducted according to modified Berlin-Frankfurt-Munster (BFM; n = 69) regimen or New York (n = 13) regimen. In 38% of patients cranial radiotherapy (CRT) was used in median dose of 18.2Gy (m: 14Gy; M: 24Gy). Median age at diagnosis was 4.5 (m: 1 year; M: 16.9 years) and median time from completion of ALL treatment was 3.2 years (m: 0.5 year; M: 4.3 years). Patients with BMI ≥85 percentile were classified as overweight. Correlation of plasma levels of leptin and leptin soluble receptor, and polymorphisms of leptin gene -18G > A, leptin receptor genes K109R and Q223R, and the overweight status were analyzed in relation to gender, intensity of chemotherapy (high intensity vs. standard intensity regimens) and to the use of CRT. Results Significant differences of leptin levels in patients treated with and without CRT, both in the entire study group (22.2+/- 3.13 ng/ml vs. 14.9+/-1.6 ng/ml; p < 0.03) and in female patients (29.9+/-4.86 ng/ml vs. 16.9+/-2.44 ng/ml; p = 0.014), were found. Significant increase of leptin levels was also found in overweight patients compared to the non-overweight patients in the entire study group (29.2+/-2.86 ng/ml vs. 12.6+/-1.51 ng/ml; p < 0.0001), female patients (35.4+/-6.48 ng/ml vs. 18.4+/-2.5 ng/ml; p = 0.005), and male patients (25.7+/-2.37 ng/ml vs. 6.9+/-0.95 ng/ml; p < 0.0001). Negative correlation was observed for plasma levels of soluble leptin receptor and overweight status, with significant differences in overweight and non-overweight patients, both in the entire study group (18.2+/-0.75 ng/ml vs. 20.98+/-0.67 ng/ml; p = 0.017) and in male patients (18.2+/-1.03 ng/ml vs. 21.8+/- 1.11 ng/ml; p = 0.038). Significant (p < 0.05) negative correlation was found between leptin and leptin receptor levels in the entire group (correlation coefficient: 0.393) and in both gender subgroups (correlation coefficient in female patients: -0.427; in male patients: -0.396). Conclusions The prevalence of overweight in our cohort was higher than in general European population (31% vs 20%) and increased regardless of the use of CRT. Leptin and leptin receptor levels may be used as useful markers of high risk of becoming overweight in ALL survivors, particularly in females treated with CRT. Polymorphisms of leptin gene -18G > A and leptin receptor genes K109R and Q223R were not associated with overweight status in ALL survivors.

The structure and turnover of polichlorinated biphenyls (PCB) in environment was presented. The PCB absorption and metabolism in organisms as well as the PCB influence on neoplastic process.

Cardiovascular autonomic function is measured as heart rate variability (HRV). The aim of the study was the HRV comparison between type 1 diabetic patients without (R0) and with diabetic retinopathy (R1). The group R0 was significantly younger (36.08 +/- 13.52 years) than group R1 (42.90 +/- 10.42 years). Diabetes duration was significantly longer in the group R1 as compared to group R0 (22.60 +/- 8.72 years vs 16.72 +/- 11.54 years, p0.04). Also HbA1c level in the group R1 was significantly higher as compared to the group R0 (p = 0.006). The data demonstrated that abnormal HR variability measured over a 24-h period provides information on the risk of sudden death. To assess HR variability twenty four hour EKG monitoring were performed in all examined patients. RR intervals were significantly longer between 2.00 a.m. and 5.00 a.m. In each hour of 24-h EKG Holter monitoring VLF and LF were significantly lower in the group R1. In the group R1 - HF was also significantly lower but only during sleeping time (between 11 p.m. and 7 a.m.). 24-h EKG monitoring is a useful and promising tool in diabetic patients with different microvascular complications.

Celiac disease, called gluten enteropathy, is a chronic disorder, characterized by the immunologic answer to the gluten contained in the wheat, barley and oat in genetically predisposed patients. The frequency of celiac disease is estimated on 0.5-1% in the adult population and proportion of diagnosed to non-diagnosed cases is 1 to 7. The clinical picture of that disease in adults presents wide spectrum of gastrointestinal and extraintestinal symptoms. There is 5-10 fold increased risk of its coexistence with other autoimmune diseases, such as diabetes mellitus type I, juvenile arthritis or autoimmune thyroiditis. Abnormal liver function or vascular thrombosis are also observed. Acute abdominal pain as the leading symptom is present in 16.3% of celiac cases. Moreover the increased frequency of the microscopic colitis and gastritis may influence on the persistence of clinical symptoms.

Contraceptive is an important issue of women's life. In the present times there are many methods to prevent unwanted pregnancy. Each of them has its advantages and disadvantages and an appropriate choice of the method determines its promotion high efficiency and comfort its application. Today there is no method of contraception, which would not be charged some risk for the application. Following the review will allow literature to analyze impact of the various methods for the development of cancer control means diseases which may constitute a serious threat to health and life women.

Estimation of underfoot pressure distribution of female patients with obesity and bilateral plantar fasciitis.45 women aged 58 (SD +/- 9.0) with obesity confirmed by BMI (BMI = 38.2, SD +/- 5.1) and hindfoot-related bilateral pain complaints typical for plantar fasciitis. The control group consisted of 50 women with no obesity and pathologies of motor apparatus found.Clinical and radiological examination and postural pedobarography. The underfoot pressure was determined at defined foot regions according to modified Blomgren classification.When compared with the control group, patients with obesity had increased pressure within metatarsus, mainly in its lateral part and within anterior part of hindfoot (MT5, MM, LM, T zone). The maximal value of underfoot pressure was 1052 g/cm2 in patients with obesity and 784 g/cm2 in the control group. There were no statistically significant differences found between underfoot pressures and stronger and lesser pain complaints occurring in one patient.1) In obese women with bilateral plantar fasciitis increased underfoot pressure mainly in the lateral part of metatarsus and anterior part of hindfoot was revealed. 2) The above changes correlate with feet dysfunction confirmed during the interview and through the physical examination.

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

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

Coeliac disease (gluten enteropathy) is a chronic inflammatory disease of the gastrointestinal (GI) tract of autoimmune etiology in genetically predisposed individuals. It is the most frequent enteropathy with frequency of 1/100 and 1/300 in the adult population in America and Europe respectively. Typical form of celiac disease including abdominal pain, weight loss, nausea is quite rare in adults. In some coeliac patients, symptoms persist in spite of strict gluten free diet. One of the reasons of this is interference of the autoimmune diseases. Results of our studies revealed in the group of 110 patients with diagnosed gluten enteropathy, coexistence of autoimmune disease, such as diabetes mellitus type 1 in 7.2% cases, hyperthyreosis on 1.8% of cases, vitiligo in 0.9% of cases, primary biliary cirrhosis in 2% of cases and rheumatoidal arthritis in 0,9 of cases. In the group of 80 ulcerative colitis patients, coexistence of celiac disease basing on serological histopatological investigation was found in 4 patients (5%).Coexistence of coeliac disease with other autoimmune diseases is quite frequent. Gluten enteropathy symptoms may be interpreted as originating from other autoimmune disease. It can delay the diagnosis of celiac disease and introduction of gluten free diet, which improves the quality of life and protects from dangerous GI complications.

Celiac disease (gluten enteropathy) is chronic immunomediated disorder of gastrointestinal tract in genetically predisposed patients. We present the case of 46 years old man, with already diagnosed several autoimmune disorders, such as: diabetes mellitus LADA type, Graves-Basedow disease and vitiligo. Despite treatment of the above diseases, diarrhea and persistent abdominal pain was observed. Diagnosis of gluten enteropathy based on serology and histological evaluation of biopsies from distal part of duodenum enabled us to introduce gluten free diet, which contributed to attenuation of symptoms and better control of glucose serum levels. We think, that celiac disease should be taken into the consideration in differential diagnosis of chronic diarrhea and persistent abdominal pain, especially in patients with coexisting autoimmune diseases.

Celiac disease is the status of the autoimmune answer provoked by gluten ingestion in genetically predisposed people. Recently gluten entheropathy was considered as a rare clinical problem in adults. Celiac disease is an autoimmune disorder that can coexist with other diseases, such as diabetes mellitus type 1 (DMID), thyroid gland diseases. The aim of our study was evaluation of the frequency of coexistence of celiac disease with DMID using the level of anti tissue transglutaminase antibodies (IgA- tTG) and mucosal biopsy from the distal part of the duodenum. An attempt was made to estimate the influence of celiac disease on the intensity of clinical symptoms and metabolic balance in patients with DMID. Our study included 109 patients with DMID, aged 18-52 years. The frequency of the incidence of celiac disease in DMID patients was 9.71%. Gastric symptoms, such as diarrhea, abdominal pain were more frequent in patients with villous atrophy in the intestine. Hyperglycemia and problems with glucose balance in the serum were observed. Introduction of the gluten free diet led to improvement quality of life, less frequent hypoglycemic episodes and disappearance of diarrhea, increase of serum iron and decrease of IgA-tTG level in the serum. It is necessary to measure the level of IgA- tTG in patients with DMID. Diagnosis of celiac disease in patients with DMID and its treatment with gluten free diet causes the clinical, histological and biochemical improvement in these patients.

Celiac disease is increasingly recognized autoimmune enteropathy caused by a permanent gluten intolerance. Gluten is the main storage protein of wheat, in genetically predisposed individuals. Celiac disease risk in first degree relatives is about 10%. Diarrhea and changes of bowel movement, observed as well in celiac disease as in IBS, may lead to misdiagnosis of IBS basing on the Rome criteria or may be associated with coexistence of both diseases. The aim of the study was to assess the celiac disease prevalence in patients with irritable bowel syndrome. The study group comprised 200 patients (120 women and 80 men) aged 18-78 years (mean: 46.7 years) with diarrhoeal form of irritable bowel syndrome (IBS), according to the Rome criteria II. At the beginning and after a three month period anti tissue transglutaminase antibodies (IgA tTG) were estimated. Gastroscopy with biopsy where performed in those with IgA tTG titre above 1/200. 40 patients were immunologically positive and 14 of them have histopathologically proven celiac disease. In the group of patients with detected celiac disease, gluten free diet was applied besides the treatment with trimebutin or mebewerin, recommended for IBS. After 6 months the decrease of IgA tTG titre in the serum was observed. In 5 of these patients IgA tTG level was negative. It was associated with the significant decrease of clinical symptoms, such as diarrhea and flatulence. The remaining symptoms, such as abdominal pain, feeling of incomplete defecation demanded continuation of IBS treatment. With regard to often atypical celiac disease symptoms--adult active searching should be performed to differentiate from irritable bowel syndrome.

Functional dyspepsia belongs to functional disorders of the gastrointestinal tract. Its prevalence is estimated up to 25% of adult population of Western countries. On the contrary to irritable bowel syndrome, functional dyspepsia is slightly more frequent in men. The recent classification of functional dyspepsia includes its two subcategories: postprandial distress syndrome (DS, B1a) and epigastric pain syndrome (EPS, B1b). In the management of functional dyspepsia three strategies are taken into the consideration: 1. early gastroscopy performed in people over 45 years of age and independent of age in case of alarm symptoms. 2. Therapy based on noninvasive H. pylori testing: in young adults with dyspeptic symptoms, without alarm symptoms and not treated with nonsteroid antiphlogistic medications. 3. Empiric treatment: considered as an initial therapy in patients not diagnosed with dyspepsia, without alarm symptoms and in dyspeptic patients despite H. pylori eradication. In the treatment of functional dyspepsia the following treatments are applied: dietary treatment, farmacotherapy with antisecretory drugs, prokinetics, H. pylori eradication, antidepressants and psychotherapy. Directions of the further investigation in functional dyspepsia include: improvement of endoscopic methods, and searching for new groups of medications according to the new Rome III classification of functional dyspepsia, based on its pathophysiology.

Although serum amyloid A (SAA) was discovered almost 25 years ago, its biological role is still unknown. Similarly to C-reactive protein, SAA belongs to acute reaction proteins, synthesised in the liver after stimulation by proinflammatory cytokines like: TNFalpha, IL-1beta and IL-6. SAA level in acute inflammatory process of bacterial, mycotical, autoimmunological, oncological or extensive tissue damage is from 100 to 1000 mg/l. Additional SAA examination in patients with oncological disorders is accepted as a valuable survival index.

Interleukin-18 (IL-18) is a proinflammatory pleiotropic cytokine playing a major role in the inflammatory cascade. It was written up for the first time in 1995 as a factor inducing interferon gamma in Kupffer cells, macrophages as well as T and B cells. Authors are presenting actual publications concerning usefulness in interleukin 18 determination in clinical diagnostics.

The influence of microbiological factor is taken into consideration in the pathogenesis of ulcerative colitis (UC). The aim of studies was to: 1.evaluate the presence of significant fungal colonization, over 10(5) CFU/ml in patients with UC and the control group (irritable colon syndrome, IBS); 2. estimate the influence of antifungal treatment in the activity of UC.We evaluated 72 patients aged from 18-72 years, 60 patients with UC, 12 with IBS. Clinical investigation: initially and after 4 weeks interview and colonoscopy with colon biopsies for histology and mycology were taken. Activity of UC was evaluated according to: clinical, endoscopic and histological IACH criteria. 13 patients with significant fungal colonization were given antifungal treatment. Biopsies for histology were stained with hematoxylin-epsin (H-E). Qualitative and quantitative mycolo-gical evaluation was performed according to Muller method.1. Significant fungal colonization was more frequent in patients with UC history over 5 years, in comparison with shorter disease history and IBS, in 33.3%, 13.8% and 1.3% respectively. 2. Candida albicans was most often isolated in 91.7% of cases. 3. Initial analysis of the activity index of UC in patients with significant and non-significant fungal colonization did not revealed differences between these groups, 13.84 and 14.0 respectively. 3. After 4 weeks stronger decrease of the UC activity index was observed in patients with significant fungal colonization treated with antifungal treatment, in comparison with patients not given antifungal therapy: 8.0 and 10.41 respectively, p0.01. Differences were significant according to clinical 2.23 (C) -3.33 (D), p0.05 and endoscopic cryteria: 3.46 (C) -4.84 (D), p0.01.1. Significant fungal colonization of colon may influence the activation of UC. 2. Longer disease history may be the risk factor of significant fungal colonization in colon. 3. Antifungal treatment in patients with significant colonization caused clinical improvement of UC.

Cardiovascular and renal complications among type 1 diabetic patients are predictive factors for sudden cardiac death and stroke. The aim of the study was to assess the prevalence of diabetic nephropathy and autonomic neuropathy in type 1 diabetic patients with and without diastolic dysfunction in echocardiographic examination. The study was performed in a group consisting of 37 patients with type 1 diabetes mellitus. Mean age of the study group equaled 37.24 +/- 10.85 years, duration of diabetes mellitus 21.3 +/- 9.55 years. All patients performed EKG, and cardiovascular autonomic test with ProSciCard according to Ewing battery. The following parameters were assessed: heart rate (HR), standard deviation of HR, RMSDD, VLF, LF, HF, deep breathing test, Ewing supine test and Valsalva maneuver. Systolic and diastolic function was assessed in echocardiography examination at rest. In all patients following laboratory parameters were assessed: HbA1c, total chol, LDL-chol, HDL-chol, triglicerides, uremic acid, glucose, albumin, creatinine, cystatin C, microalbuminuria.mean heart rate in the examined group --78.38 +/- 15.54 /min, VLF--1.59 +/- 1.7; LF--4.22 +/- 1.51, HF--0.82 +/- 0.88, mean heart rate during deep breathing test --79.63 +/- 13.71, Ewing ratio--0.91 +/- 0.11. Cardiovascular autonomic neuropathy and diabetic neuropathy were diagnosed in 3 patients, these patients suffered also from proliferative retinopathy and diabetic nephropathy. The remaining group of 34 patients has normoalbuminuria. Calculated creatinine clearance according to Cockroft-Gault equation was 88.85 +/- 9.60 m/min, cystatin C concentration--0.97 +/- 0.22 ng/ml. In echocardiography exam, there were no abnormalities in systolic function, and diastolic dysfunction was diagnosed in 15 patients. Preliminary results showed that only the cystatin C level significantly differed patients with and without diastolic dysfunction in echocardiographic examination. Cystatin C could be the first sign of renal failure among these patients. Cardiovascular autonomic neuropathy and diabetic nephropathy were diagnosed only in 3 patients with left ventricular diastolic dysfunction in echocardiographic study.

Neopterin is a low-molecular mass substance synthesized from guanosine triphosphate (GTP) in monocytes/macrophages due to IFNgamma stimulation. The cellular immune system is involved in or affected by the disease process in various conditions such as viral infections (AIDS), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosis, Crohn's disease), malignancy and monitoring after solid organ transplants. Similar to procalcitonin, neopterin determination can assist in the differential diagnosis between viral and bacterial infection and as an indicator for impending septic complications (MODS vs. sepsis). Because of fact that reduced glamerular filtration rate neopterin accumulates in the blood, neopterin determination in multiorgan failure or sepsis patients are limited. The aim of this study was to evaluate the usefulness of neopterin in clinical diagnostics.

A large number of publications, primarily clinical studies, demonstrate the increasing use of procalcitonin (PCT) in modern clinical practice. PCT is a propeptide of calcitonin induced by a variety of stimuli including bacterial endotoxins, proinflammatory cytokines and triggering events such as trauma or cardiogenic shock. PCT is not or only slightly induced by viral infections, autoimmune disorders, neoplastic diseases and organs transplantation. The aim of this study was to evaluate the usefulness of PCT as a diagnostic and prognostic tool in patients for early differentiation between bacterial and nonbacterial infection origin.

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

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

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

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

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

We are most grateful to Dr Karamitsos et al. for showing such an avid interest in our paper.1 Upon its submission, we were acutely aware that we might well shake things up, as prior to confronting the actual study results we also used to support the notion of diabetic cardiomyopathy (DC). By way of addressing some of Dr Karamitsos's queries,2 let me point out that our results were clearly owed to rather stringent inclusion criteria; a prerequisite condition for diagnosing/ruling out DC. All patients with microalbuminuria (with both normal and abnormal renal function) were excluded from the study …

The aim of the study is to evaluate the prevalence and incidence of myocardial dysfunction (MD) and heart failure (HF) in long-lasting (≥10 years) type 1 diabetes without cardiovascular disorders or with hypertension or coronary heart disease (CHD). The study included 1,685 patients with type 1 diabetes (mean baseline age, 51 years; diabetes duration, 36 years). In all patients, echocardiography was performed, NT-proBNP levels were measured, and clinical symptoms were evaluated. A 7-year follow-up was conducted to monitor systolic and diastolic manifestations of MD and HF. At the end of the follow-up period, the prevalence of HF in the entire group was 3.7 %, and the incidence was 0.02 % per year. The prevalence of MD was 14.5 % and the incidence –0.1 % per year. MD and HF were observed only in hypertensive or CHD patients. At baseline, subjects with diastolic HF constituted 85 % of the HF population and those with systolic HF the remaining 15 %. Baseline HF predictors included age, diabetes duration, HbA1c levels, CHD, systolic blood pressure >140 mmHg, and GFR