Arterial Stiffness, BMI, Dipping Status and ACE D/I Polymorphism in Type 1 Diabetic Children.

THE AIM: of the study was to investigate clinical and genetic determinants of arterial stiffness in children and adolescents with type 1 diabetes mellitus. MATERIAL AND METHODS: 122 patients (mean age: 16.0±2.35 years), with an average diabetes duration of 5.0 years and without evidence of arterial hypertension were recruited. Ambulatory arterial stiffness index (AASI) was assessed with 24-h automatic blood pressure monitoring. Body weight, height, HbA1c and plasma lipids were measured. Angiotensin I converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism was analysed. RESULTS: Mean AASI equalled 0.22±0.20 and showed significant, positive correlation with age and BMI-SDS. No association was found between AASI and gender, diabetes duration, daily insulin dose, HbA1c and blood lipids concentration. AASI was higher in non-dippers compared to dippers (0.26±0.18 vs. 0.19±0.18, respectively; p=0.04). In a multivariate model AASI was significantly associated with II homozygosity of ACE gene (p=0.007). CONCLUSIONS: In type 1 diabetic children and adolescents AASI is correlated with age and BMI-SDS. Non-dipping status and I-allele were associated with higher arterial stiffness.

Glycemic variability in patients with Wolfram syndrome is lower than in type 1 diabetes.

AIMS: Wolfram syndrome (WFS) is diagnosed as coexistence of diabetes mellitus and optic atrophy, where pancreatic beta cell destruction is associated with neurodegeneration. Typically, WFS necessitates insulin treatment similar to type 1 diabetes (T1D), but the mechanism of beta cell mass reduction leading to hyperglycemia is different. METHODS: The aim of the study was to assess glycemic variability using the continuous glucose monitoring (CGM) system in seven pediatric patients with genetically confirmed WFS and compare the results with data obtained from 21 propensity score-matched patients with T1D. The "GlyCulator" application was used for the calculation of glycemic variability indices. RESULTS: CGM recordings showed similarities in glycemic variability among WFS patients, but differing from those of the T1D group. Coefficient of variation (%CV), CONGA4h, and GONGA6h were significantly (p < 0.05) lower in WFS patients (28.08 ± 7.37, 54.96 ± 11.92, and 55.99 ± 10.58) than in T1D patients (37.87 ± 14.24, 74.12 ± 28.74, p = 0.02, and 80.26 ± 35.05, respectively). In WFS patients, the percentage of values above 126 mg/dL was 69.79 (52.08-77.43), whereas in patients with T1D, the percentage was significantly lower-47.22 (35.07-62.85, p = 0.018). Curiously, a tendency toward a lower percentage of measurements below 70 mg/dL was noted in the WFS group [0 (0-7.29)] in comparison with the T1D group [6.25 (0-18.06), p = 0.122]. WFS patients had a significantly higher C-peptide level (0.31 ± 0.2 ng/mL) than T1D patients (0.04 ± 0.04 ng/mL; p = 0.006). CONCLUSIONS: Patients with WFS show smaller glycemic variability than individuals with T1D, and this may be associated with persistent residual insulin secretion.

Non-dipping and arterial hypertension depend on clinical factors rather than on genetic variability of ACE and RGS2 genes in patients with type 1 diabetes.

The aim of our study was to characterize the association of clinical and genetic risk factors such as: ACE genotype (rs17997552, rs1800764, rs4459609) and RGS2 (rs2746071) with the development of hypertension (HT) and non-dipping phenomenon in patients with type 1 diabetes mellitus (T1DM). A total of 238 adolescents and young adults with T1DM-103 females and 135 males, aged 8-30 years (mean 17.35 ± 5.2) with diabetes duration 1-26 years (mean 7.72 ± 6.2), with mean HbA1c (IFCC) 58 ± 15 mmol/mmol-were subjected to 24-h ambulatory blood pressure measurements (ABPM). The results of the ABPM were analyzed in association with the polymorphisms of ACE and RGS2 genes and clinical data of patients. HT was recognized in 65 (27 %) and non-dipping in 111 (46.63 %) patients. In the multivariate analysis of factors predisposing to HT, the variables that remained significant were the following: male sex (OR 1.62; 95 % CI 1.171-2.250), non-dipping (OR 1.40; 95 % CI 1.03-1.90) and total cholesterol level (OR 1.01; 95 % CI 1.005-1.021). The only factor influencing non-dipping was the duration of diabetes-OR 1.09 (95 % CI 1.04-1.14). The patients displaying non-dipping have a twice increased risk of development of HT (OR 2.17; 95 % CI 1.21-3.89). There was no association between disturbances of blood pressure (BP) and genotypes of ACE: rs17997552, rs1800764, rs4459609 and RGS2: rs2746071. Clinical rather than genetic risk factors seem to be connected with BP disturbances in young patients with T1DM. Although we have identified representative groups of HT versus non-HT and dipping versus non-dipping subjects, the effect of genetic predisposition to the development of higher BP is too weak to be statistically significant.

Delayed recognition of Wolfram syndrome frequently misdiagnosed as type 1 diabetes with early chronic complications.

AIMS: Improvements in diagnostic methods and greater genetic awareness have brought remarkable progress in the recognition of monogenic forms of diabetes, including Wolfram syndrome (WFS). WFS is diagnosed based on clinical criteria of coexistence of diabetes mellitus and optic atrophy, and confirmed by molecular analysis; however, the condition is still sometimes misdiagnosed. To begin to understand the reasons for misdiagnosis, we conducted a retrospective analysis of WFS patients who were originally misdiagnosed. MATERIALS AND METHODS: The medical histories of 13 pediatric patients with clinical misdiagnosis of type 1 diabetes and early chronic complications made in the years 1995-2010 and who were subsequently correctly diagnosed with WFS based on genetic testing in 2008-2011 were analyzed. RESULTS: The average age of the patients at diabetes onset was 5 (4.4-6.3) years, and the mean HbA1c level at diagnosis was 9.1±2.3%. Initially, all of these patients were treated as having type 1 diabetes with progressive visual impairment despite good metabolic control (mean HbA1c 7.5±1.3%). Diagnosis of optic atrophy was made at an average age of 9 (5.9-11.5) years, which corresponds to 4 years after diabetes recognition (p=0.002). At the time of genetic analysis, the average age of the patients was 16 (12-18.7) years, which corresponds to 7 years after recognition of coexistence of diabetes mellitus and optic atrophy (p=0.007). CONCLUSIONS: Delays of at least 7 years occurred before recognition of WFS among a cohort of pediatric patients with diabetes. All patients with WFS were primarily misdiagnosed as having type 1 diabetes.

Prevalence of monogenic diabetes amongst Polish children after a nationwide genetic screening campaign.

AIMS/HYPOTHESIS: The aim of this study was to study dynamic changes in the prevalence of different types of diabetes in paediatric populations in Poland, with a specific focus on monogenic diabetes (MD). METHODS: Using epidemiologic data (PolPeDiab Collaboration) and nationwide genetic test results (TEAM Programme), we compared the prevalence of type 1, type 2 and cystic fibrosis-related diabetes (CFRD) and MD. Genetically confirmed MD included MODY, neonatal diabetes and Wolfram and Alström syndromes. The study covered all children aged 0-18 years treated for diabetes between 2005 and 2011 in three regions, inhabited by 23.7% (1,989,988) of Polish children, with a low prevalence of childhood obesity (<5%). RESULTS: The prevalence of type 1 diabetes showed a continuous increase, from 96 to 138/100,000 children. The prevalence of type 2 diabetes and CFRD also increased, from 0.3 to 1.01/100,000 children and from 0.1 to 0.95/100,000 children, respectively. The prevalence of MD was stable at between 4.2 and 4.6/100,000 children, accounting for 3.1-4.2% of children with diabetes, with glucokinase (GCK)-MODY being the most frequent type, amounting to 83% of patients with MD. The percentage of positive test results decreased with the number of referrals, suggesting that children with the highest probability of MD were referred initially, followed by those with a less clear-cut phenotype. The prevalence of neonatal diabetes equalled 1 in 300,000 children. CONCLUSIONS/INTERPRETATION: The prevalence of MD in a paediatric population with a low prevalence of obesity remains stable and is nearly fivefold higher than that of type 2 diabetes and CFRD, justifying a need for increased access to genetic diagnostic procedures in diabetic children.

Wolfram syndrome in the Polish population: novel mutations and genotype-phenotype correlation.

OBJECTIVE: Wolfram syndrome is a rare form of diabetes mellitus associated with optic atrophy and disorders of different organs (e.g. diabetes insipidus, hearing loss, ataxia, anaemia and many others). This syndrome is caused by recessive mutations in the wolframin gene (WFS1) localized on chromosome 4p16·1. The aim of this study was to identify the causative mutations in WFS1 in a group of Polish patients with suspected Wolfram syndrome. PATIENTS AND MEASUREMENTS: Nine patients with clinical symptoms consistent with Wolfram syndrome (at least diabetes mellitus and optic atrophy) and 22 first-degree relatives were examined. The molecular analysis was carried out by direct sequencing of the exons, the exon-intron junctions, and the 5' and 3' untranslated regions of WFS1. RESULTS: Nine different mutations in WFS1 (five of them novel) were identified in the nine patients. Six patients were homozygous for the following mutations: V412fs, S443R, W539X, V659fs. They developed diabetes at a mean age of 5·2 years. Three patients were compound-heterozygous for the following mutations: S167fs, Q392X, Y513fs, W648X, V779G. They developed diabetes at a mean age of 6·5 years. CONCLUSIONS: Mean age of diagnosis of diabetes among the Polish patients was typical for Wolfram syndrome; however, compound-heterozygous patients were slightly older at diabetes onset.

Immunogenicity of different brands of human insulin and rapid-acting insulin analogs in insulin-naïve children with type 1 diabetes.

AIMS: To determine (i) whether insulin preparations produced by three companies induce the same immune responses in insulin-naïve children with type 1 diabetes (T1DM); (ii) if switching from human insulin to rapid-acting insulin analogs influences this immune response; and (iii) if different insulin brands produce different clinical results during the first 2 yr after T1DM diagnosis. METHODS: Insulin antibodies (IA) were measured for 140 patients aged 1.4-17.6 yr. Regular human insulin, neutral protamine Hagedorn (NPH) human insulin, and rapid-acting insulin analogs (lispro or aspart) taken by the patients were produced by one of three companies: Bioton, Poland (A), Eli Lilly, USA (B) and NovoNordisk, Denmark (C). RESULTS: Positive IA levels were found in 112 patients (80.0%) at baseline and in 137 (97.9%) at 6 and at 24 months after T1DM diagnosis. There was no difference in IA levels among patients taking insulin preparations produced by different companies at 6 months (mean ± SD, A 27.8 ± 15.7%; B 25.3 ± 15.4%; C 24.5 ± 14.2; p = 0.54) or at 24 months (A 25.6 ± 17.8%; B29.6 ± 17.0%; C 26.2 ± 17.0%; p = 0.52); HbA(1c) and daily insulin dose did not differ significantly either. After 24 months, IA levels were similar for those who had used human insulin (mean ± SD, 25.7 ± 17.2%) and for those that had added rapid-acting analogs (28.1 ± 17.3%, p = 0.41). CONCLUSIONS: Three brands of insulin preparations did not differ with respect to immunogenicity. Rapid-acting analogs did not increase IA levels in patients previously treated with human insulin only. Patients using insulin preparations of different brands did not differ with respect to daily insulin dose or HbA(1c) .

Insulin sensitivity in Type 1 diabetic children and adolescents.

AIM: To estimate insulin sensitivity in Type 1 diabetic children and adolescents, and assess the relationship between insulin sensitivity and clinical markers of adiposity and parameters of the metabolic syndrome. METHODS: A total of 202 patients aged 8-18 years with Type 1 diabetes and disease duration 1.5-15 years participated. Insulin sensitivity was estimated by glucose uptake during an euglycaemic-hyperinsulinaemic clamp and was calculated as the average amount of glucose (M(lbm) = mg/kg(lbm)/min) required to maintain euglycaemia. Blood pressure, glycated haemoglobin (HbA(1c)) and lipid concentrations were measured. RESULTS: The M(lbm )value ranged from 4.14 to 25.25 mg/kg(lbm)/min (mean 9.81 +/- 3.34 mg/kg(lbm)/min). There was a significant relationship between M value and patients' age (r = -0.38, P < 0.0001). Insulin sensitivity decreased significantly with the onset of puberty; hence, it was significantly lower in pubertal and post-pubertal adolescents. Girls were significantly more insulin resistant than boys (9.01 +/- 0.32 vs. 10.43 +/- 0.29 mg/kg(lbm)/min, P = 0.005). Insulin sensitivity correlated with body mass index (r = -0.29, P < 0.001), waist circumference (r = -0.35, P < 0.001), triceps skin fold (r = -0.17, P = 0.018), subscapular skin fold (r = -0.23, P = 0.001) and body fat (r = -0.19, P = 0.006). There was a relationship between M(lbm) value, cholesterol (r = -0.18, P = 0.012), high-density lipoprotein cholesterol (r = 0.15, P = 0.035), low-density lipoprotein cholesterol (r = -0.22, P = 0.002), triglycerides (r = -0.32, P < 0.001) and systolic blood pressure (r = -0.15, P = 0.029). Insulin resistance was related to HbA(1c) (r = -0.18, P = 0.012). Additionally, there was a correlation between M(lbm) value and insulin dose. CONCLUSIONS: Children and adolescents with Type 1 diabetes mellitus have a very wide range of insulin sensitivity, which is determined by sex, age, amount of adipose tissue and glycaemic control.

Platelet aggregation and prostaglandin metabolism in uremic patients.

The pathogenesis of depressed platelet activity in uremia is still unknown. The influence of some uremic toxins on platelet aggregation (PLA) and prostaglandin metabolism in 50 uremic patients treated by hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) was studied. Fifty-seven healthy volunteers (HVs) served for reference values. Adenosine diphosphate (ADP) and thrombin (Thr) were used as agonists of PLA. PLA was determined using the Born method. Malonyldialdehyde (MDA) levels in platelets as an indicator of prostaglandin metabolism, after stimulation with arachidonic acid, were measured according to Stuart. The relationship of PLA and prostaglandin metabolism with plasma concentrations of methylguanidine (MG), guanidinosuccinic acid (GSA), and creatinine (Cr) was assessed. PLA-ADP values in regular HD patients (42 +/- 5 mm) were significantly lower than in CAPD patients (65 +/- 8 mm) and HVs (73 +/- 3 mm). PLA-Thr values in HD patients (25 +/- 4 mm) were significantly lower than in CAPD patients (34.9 mm) and HVs (36 +/- 3 mm). MDA levels in HD patients (7 +/- 1 nmol/L/10(9)) were significantly lower than in CAPD patients (12 +/- 2 nmol/L/10(9)) and HVs (15 +/- 1 nmol/L/10(9)). In HD patients, inverse correlations of PLA-ADP with MG levels (r = -0.92), PLA-Thr with Cr levels (r = -89), and MDA levels with GSA levels (r = -0.86) were found. In CAPD patients, no relationship of PLA and MDA with uremic toxins was observed. Depressed activity of platelets and prostaglandin metabolism was strongly expressed in HD patients.

Erythrocyte transketolase activity and guanidino compounds in hemodialysis patients.

BACKGROUND: The toxic effects of guanidino compounds on enzymatic activity in uremic patients are known. Thus, we determined the hemodialysis (HD) impact on this toxicity. METHODS: The erythrocyte transketolase activity (ETKA), total guanidino compounds (TGCs), and guanidinosuccinic acid (GSA) levels in plasma were compared before, after 5 hours of HD, and at 12 and 24 hours from the end of HD. Thirty-seven HD patients (28 to 49 years old) with primary glomerulopathies participated in this study. Thirty healthy volunteers (HVs) served as controls. RESULTS: At the beginning of this study, ETKA was lower in uremics (1.94 +/- 0.45) than in HVs (2.59 +/- 0.26). The TGC and GSA plasma levels were higher (26.07 +/- 5.34 and 4.5 +/- 1.22) than in HVs (10.41 +/- 1.42 and 0.76 +/- 0.09, P < 0.001), respectively. After five hours of HD, the ETKA increased to 2.49 +/- 0.62 (P < 0.001). The plasma levels TGC decreased to 12.56 +/- 2.02 (P < 0.001) and the GSA to 2.12 +/- 0.68 (P < 0.001). After 12 and 24 hours from the end of HD, the ETKA decreased to 2.25 +/- 0.56 and 2.09 +/- 0.49 (P < 0.001), respectively. The plasma levels for TGC and GSA both increased: TGC to 19.39 +/- 3.67 and 25.68 +/- 4.61 (P < 0.001), respectively; GSA to 3.49 +/- 1.11 and 4.53 +/- 1.12 (P < 0.001), respectively. CONCLUSION: There was no significant correlation between ETKA and the plasma levels of the examined toxins. By removing the guanidino compounds, HD temporarily decreases the inhibition of ETKA, diminishing other metabolic disturbances connected with pentose phosphate cycle.

[The effect of cocarboxylase treatment on erythrocyte transketolase and blood thiamine in patients with end stage renal disease undergoing maintenance hemodialysis]. / Wplyw leczenia kokarboksylaza na aktywnosc transketolazy w erytrocytach i stezenie tiaminy we krwi u chorych ze schylkowa niewydolnoscia nerek, leczonych powtarzana hemodializa.

The depressed ETKA in ESRD patients is supposed to be caused and/or aggravated by several factors among which the diminished content of thiamine in blood and/or disturbances of thiamine utilization seem to play the major role. This role stems from the fact that thiamine acts as the cofactor of transketolase. In order to check the therapeutic significance of this relationship we introduced the thiamine pyrophosphoric acid ester chloride (Cocarboxylasum-CC) administration in 25 patients (mHD + CC). Immediately after each HD performance CC was given i.v. during 12 weeks in a doses of 5 mg/kg b.w., 3 times a week. The blood for ETKA value, free and total thiamine in plasma and erythrocytes, as well as, the total protein and albumins/globulins index investigation was drawn before, after 6 and 12 weeks of CC administration, and 3 months after cessation of this therapy. In 10 patients, on maintenance HD nontreated by CC (mHD), the blood was drawn at the same time intervals. Normal values we obtained from 15 healthy volunteers. For ETKA evaluation photocolorimetric method was used, thiamine content in blood was estimated by fluorimetric method. At the beginning of the study the mean value of ETKA, in two examined groups, was found statistically decreased (p < 0.01) when compared with normals. Mean values of thiamine in plasma and erythrocytes were lower but did not differ significantly from those in normals. After 6 weeks of CC administration ETKA value increased, but only after 12 weeks it increased significantly (p < 0.01), reaching normal value. On the other hand, striking increase in plasma thiamine and erythrocyte thiamine levels was observed after 6 weeks of CC administration already (p < 0.01). Three months after cessation of CC administration significant decrease in ETKA value and thiamine level in blood was observed (p < 0.01). ETKA returned to lower value than in normals even in the presence of still high thiamine levels in blood. In mHD patients nontreated by CC the ETKA value and thiamine levels in blood did not change significantly during all periods of study. The nutritional status assessed by total protein and albumins/globulins index did not change in both groups through the study. We conclude, the administration of high doses of CC to ESRD patients on maintenance hemodialysis HD was successful in terms of increasing ETKA value and thiamine levels in blood without any side effects. Thus, supplementation with large doses of CC deserves further study because it promises to be another adjunct in the treatment of potential thiamine deficiency and metabolic disturbances in the course of dialysotherapy.

Investigations on magnesium and chromium antagonism in the skin of experimental animals.

Investigations were performed over 30 days on 25 male rats Wistar breed divided into five groups. Animals received intraperitoneally (i.p.) potassium dichromate (KDCH) 5 mg/kg (basal doses, b.d.), 2 mg/kg (0.4 b.d.) and 100 mg Mg Cl2/kg body weight (b.w.). In performed investigations the highest concentration of chromium in animal skin 1.17 +/- 0.11 micrograms/g was observed by i.p. administration of KDCH 5 mg/kg b.w. Simultaneous i.p. administration of KDCH 5 mg/kg b.w. and MgCl2 100 mg/kg b.w. resulted in significant lower concentration of chromium (in comparison to the preceding group) in animal skin: 0.8 +/- 0.2 microgram/g (p < 0.001). In i.p. administration of KDCH in the doses of 0.4 b.d. the concentration of Cr in the skin amounted to 0.55 +/- 0.1 microgram/g. Values of Cr in the skin in exposed groups were significantly higher than in the control group, (p < 0.001).

[The influence of the psycho-biological factors on the level of knowledge and skills concerning the diabetes in children and adolescents with type 1 diabetes mellitus]. / Wplyw czynników biologiczno-psychologicznych na poziom wiedzy i umiejetnosci w zakresie samokontroli cukrzycy u dzieci i mlodziezy z cukrzyca typu 1.

The aim of the study was to evaluate the influence of the psycho-biological factors on the level of knowledge and skills concerning the diabetes in children and adolescents with type 1 diabetes mellitus. The study was performed in 100 patients aged 12-18 years with diabetes duration 1-13 years. Diabetes knowledge was assessed by using a 29 item diabetes knowledge test. Then practical abilities concerning self-control were estimated. The analysis of psycho-biological qualities of patients included age, sex, duration of the disease, age at onset of diabetes, education, intellectual abilities level (Raven's Standard Matrix Test) and general condition of the patient (HbA1c, occurrence of severe hypoglycaemia, co-occurrence of other chronic diseases). The best results of written and practical tests were obtained by patients at the age of 15 or more. The lowest evaluation of knowledge and practical ability was obtained by children at the age of 12-13. Practical ability level was statistically significantly higher in patients suffering for 1-2 years than in the remaining of the examined persons. Children who fell ill at the age of 0.5-6 years presented a statistically significantly lower level of knowledge in their self-control than patients who fell ill after 11 years of age. Theoretical and practical training degree in diabetes self-control showed a positive correlation with the education level of the subjects. A positive correlation between the test results and intellectual abilities of the subjects was observed within the examined group. The level of patients' health education positively correlates with their age, formal education and intelligence. Health education of children and adolescents with type 1 diabetes mellitus should be individualised and adapted to their particular qualities.

[The role of carnitine in human lipid metabolism]. / Rola karnityny w przemianie lipidowej u czlowieka.

Carnitine is an important nutrient that is present in diet (particularly in meat and dairy products) and is synthesized from amino acids. Carnitine has two principal functions in the organism. One is to transport long-chain fatty acids into the mitochondrion. The second function of carnitine is to regulate the intramitochondrial ratio of acylocoenzyme A to free coenzyme A. This function is important because it allows to remove excessive (and potentially toxic) short- and medium-chain fatty acids from the mitochondrion, and because it maintains sufficient free coenzyme A within the mitochondrion to support energy metabolism.

[Stents for treatment of transluminal percutaneous coronary angioplasty (PTCA) complications]. / Stenty w leczeniu powiklanej angioplastyki wiencowej (PTCA).

UNLABELLED: This study describes initial results of stent implantation in bailout situations in 38 patients with obstructive dissection after percutaneous transluminal coronary angioplasty (PTCA). Before stent introduction 1.8% of all patients after PTCA required emergency bypass grafting (CABG) because of postprocedural complications. In 1997 the rate of such emergency operations decreased to only 0.5% (p < 0.05). The success rate of stent deployment in patients included in the study was 95%. Mean final inflation pressure used for stent deployment was 12.0 +/- 2.3 atm. After stent implantation average residual stenosis was -0.81 +/- 5.75%. Of the 38 patients, 15 (40%) were treated before stent implantation with prolonged inflations with perfusion catheter. Bailout stenting was performed in 10 (25%) patients undergoing PTCA for restenotic lesions. The stents were placed in the left anterior descending coronary artery in 26 patients (69%), left circumflex coronary artery in 3 patients (8%), and in the right coronary artery in 9 patients (23%). Before bailout stenting 28 patients (75%) presented with type C and D dissection. One patient (2.5%) developed acute stent thrombosis. No episodes of subacute stent thrombosis were noted. During six-months clinical follow up no death and no Q-MI were observed. Angiographic follow up restenosis rate was 13/30 (43%), predominantly in patients treated with prolonged perfusion balloon inflations before stent implantation. The incidence of repeated PTCA and elective CABG due to restenosis was 12/30 (40%) and 1/30 (3%), respectively. There were no vascular complication at the puncture site. IN CONCLUSION: the introduction of coronary stenting has provided an excellent non-surgical modality for treatment of imminent or acute vascular closure complicating coronary angioplasty.

[Coronary bypass grafting after failed percutaneous angioplasty (PTCA)]. / Pilne pomostowanie tetnic wiencowych po powiklanych angioplastykach wiencowych (PTCA).

Between January 1991 and September 1997, in the Cardiovascular Surgery Department of the Institute of Cardiology of Jagiellonian University Medical School, 23 patients underwent emergency CABG due to acute myocardial ischaemia in result of failed PTCA. Over the same period of time invasive cardiologists performed 1883 PTCAs out of which 23 (1.2%) were emergency cardiosurgical procedures, and in 38 patients, stents were implanted in the damaged coronary arteries. The patients' age ranged from 37 to 67 years (median 52.2). In all patients good left ventricular function was preserved, median ejection fraction being 64%. Two patients required IABP to support left ventricular function. 1-4 bypass grafts were implanted (median 1.9 per patient). In one patient, internal mammary artery was collected and then implanted into anterior interventricular branch. The most common complication was myocardial infarction which occurred in 12 patients (52%). In ten patients low output was observed postoperatively. One operated patient (a female died (4.3%). The mean time of hospitalization was 11 days. Emergency myocardial revascularisation procedures performed after failed PTCA, bring higher risk of mortality and dangerous postoperative complications.

Comparison of the thiamine level in blood and erythrocyte transketolase activity in hemodialyzed and nondialyzed patients during recombinant human erythropoietin therapy.

Thiamine and erythrocyte transketolase activity (ETKA) disturbances in end-stage renal disease are caused mainly by uremia and dialysis treatment. We examined whether recombinant human erythropoietin (rhEPO) can correct these abnormalities in uremic patients. Thirteen hemodialysis (HD) and 12 nondialyzed (ND) anemic patients showed decreased free and total thiamine levels in plasma and in erythrocytes and decreased ETKA when compared to 20 healthy subjects. Thiamine blood levels (mumol/l) were determined using a fluorimetric technique, and ETKA (mumol/l per minute) was assessed with a photocolorimetric method. Over 20 weeks of study, rhEPO was given intravenously for 8 weeks at 50 Ul/kg body weight (BW) three times a week, and subcutaneously for 4 weeks at 25 Ul/kg BW, twice a week, and for the last 8 weeks at 25 Ul/kg BW once a week. The correction of anemia was associated with an increase in plasma thiamine and erythrocyte total thiamine as well as ETKA in HD patients and with an increase in erythrocyte total thiamine in ND patients only during the period of intravenous infusions.

["Reversible cholelithiasis" in patients with chronic renal failure treated with ceftriaxone]. / "Odwracalna kamica zólciowa" u chorych z przewlekla niewydolnoscia nerek leczonych ceftriaksonem.

Patients with chronic renal failure were admitted to the Neurological Department and symptoms of cholelithiasis were observed. Ceftriaxone therapy in one case was clinically effective.

[Pulmonary infarction as a complication of thrombotic changes in an arteriovenous fistula of a patient with terminal renal insufficiency treated with long-term hemodialysis and recombinant human erythropoietin]. / Zawal pluca jako powiklanie zmian zakrzepowych w przetoce tetniczo-zylnej u chorej na schylkowa niewydolnosc nerek przewlekle leczonej hemodializa oraz rekombinowana ludzka erytropoetyna.

The case of 48 year old female patient with terminal renal insufficiency treated with hemodialysis and human recombinant erythropoietin was observed because of pulmonary infraction. The symptoms of disease were observed in the right lung and in region of arteriovenous fistula. It was documented that therapy with human recombinant erythropoietin may induce thrombosed complications during hemodialysis with arteriovenous fistula.

Recombinant human erythropoietin improves enzyme activity in erythrocytes of predialysis uremics.

The influence of r-HuEPO on the activity of erythrocyte transketolase (ETKA), glutathione reductase (GSH) and glutamic-pyruvic transaminase (EGPT) was determined by spectrophotometry. 150 IU/kg BW/week of r-HuEPO was given i.v. during 2 months to 12 predialyzed uremics (PDU). Twenty healthy volunteers (HV) served as controls. GSH and EGPT activity were expressed as a coefficient. ETKA in HV = 2.39 +/- 0.10 and PDU = 1.53 +/- 0.10 mumol/ml/min differed significantly (p < 0.001). GSH in HV = 1.20 +/- 0.09 and PDU = 1.25 +/- 0.07, EGPT in HV = 1.20 +/- 0.10 and PDU = 1.38 +/- 0.11 differed significantly (p < 0.01 and p < 0.001, respectively). After 2 months of r-HuEPO treatment, ETKA, GSH and EGPT rose significantly (p < 0.01). Thus, r-HuEPO increases the activity of enzymes related with the content of vitamins B1, B2 and B6 in uremics.