Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population?

OBJECTIVE: The monitoring of the populations' iodine status is an essential part of successful programmes of iodine deficiency elimination. The current study aimed at the evaluation of current iodine nutrition in school children, pregnant and lactating women as a marker of the effectiveness and sustainability of mandatory iodine prophylaxis in Poland. DESIGN: The following iodine nutrition indicators were used: urinary iodine concentration (UIC) (all participants) and serum thyroglobulin (pregnant and lactating women). SETTING: The study was conducted in 2017 within the National Health Programme in five regions of Poland. PARTICIPANTS: The research included 300 pregnant women, 100 lactating women and 1000 school children (aged 6-12 years). RESULTS: In pregnant women, median UIC was 111·6 µg/l; there was no significant difference in median UIC according to the region of residence. In 8 % of pregnant women, thyroglobulin level was >40 ng/ml (median thyroglobulin 13·3 ng/ml). In lactating women, median UIC was 68·0 µg/l. A significant inter-regional difference was noted (P = 0·0143). In 18 % of breastfeeding women, thyroglobulin level was >40 ng/ml (median thyroglobulin 18·5 ng/ml). According to the WHO criteria, the investigated sample of pregnant and lactating women was iodine-deficient. Median UIC in school children was 119·8 µg/l (with significant inter-regional variation; P = 0·0000), which is consistent with iodine sufficiency. Ninety-four children (9·4 %) had UIC < 50 µg/l. CONCLUSIONS: Mandatory iodisation of household salt in Poland has led to a sustainable optimisation of iodine status in the general population. However, it has failed to assure adequate iodine nutrition during pregnancy and lactation.

The effect of acute carbon monoxide poisoning on micronuclei frequency and proliferation in human peripheral blood lymphocytes (case-control study).

OBJECTIVE: Carbon monoxide (CO) exposure is still one of the leading causes of unintentional poisonings. Although its neurological sequels have been extensively studied, the knowledge about cytogenetic conse- quences still remains very limited. The aim of this study was to estimate the genotoxic potential of carbon monoxide in the course of acute poisoning. METHODS: The examined group consisted of 73 patients treated because of accidental acute CO poisoning, and 22 healthy control individuals. Poisoning severity was estimated on the basis of neurological symptoms at admission, age, duration of exposure, carboxyhemoglobin (COHb) level and blood lactate concentration. The cytochalasine-B (cytokinesis blocker) micronucleus assay (CBMN) was used to analyze the cytogenetic alterations in lymphocytes from peripheral blood of the patients. RESULTS: Intoxicated patients displayed higher numbers of micronuclei (MN) than controls. The frequency of MN depended on the age of patients, loss of consciousness, neurological symptoms at admission, and the level of carboxyhemoglobin, but did not correlate with lactate level. We also observed differences in cell responses depending on the gender. CONCLUSION: Our results confirm the presence of cytogenetic changes after carbon monoxide poisoning. Based on these data we conclude, that CO might have genotoxic potential.

Abnormal glucose metabolism in men with alcohol withdrawal syndrome.

UNLABELLED: The aim of the study was to evaluate the glucose metabolism in patients suffering from ethanol withdrawal syndrome. The study group comprised 88 alcohol dependent men aged 21- 50 y (mean 39.18 years, SD ±7.78), treated at the Clinical Toxicology Ward. Alcohol dependence was diagnosed accord- ing to the criteria of the International Statistical Classification of Diseases and Related Human Problems (ICD-10). The degree of alcohol withdrawal syndrome was assessed according to the scale CIWA-Ar. The blood ethanol concentration, and glucose serum concen- tration were measured on admission. On the next post-admission day blood glucose were determined after fasting and at the 0, 60th and 120th minute of an oral glucose tolerance test (OGTT) using 75 g glucose. Basing on the recommendations of Polish Diabetes Association (2013y) the patients were classified into one of groups according to their glucose tolerance test results. RESULTS: Mean duration of alcohol dependence was 10.56 years ± 7.78. A mean CIWA-Ar scale score was 23.95 points ± 2.81. Mean BMI was 24.65 ±3.74, overweight and obesity were determined in 35.22% examined men. Normal glucose tolerance were found in 54.55%, abnormal fasting glucose and/or abnormal glucose tolerance were noted in 23.87%, diabetes in 10.23%, and hypoglycemia in 11.36% of examined patients. Intensity of withdrawal syndrome according to the CIWA- Ar (OR -1.59, p= 0.05) and duration of alcohol consumption (OR -1.01, p=0.03) were the risk factors of diabetes type 2 in examined group. Greater BMI was a protective factor against diabetes type 2 in the study group. There was no significant correlation between risk of hypoglycemia and age, BMI, duration of alcohol consumption, alcohol blood concentration on admission, intensity ofwithdrawal syndrome according to the CIWA- Ar scale. A higher frequency of hypoglycemia was found in patients who declared vodka drinking in interview (at the borderline of statistical significance OR - 7.43, p=0.06). CONCLUSIONS: 1. In the study group of alcohol-dependent men, the risk of diabetes was inversely proportional to BMI value. 2. The risk factors of type 2 diabetes in the alcohol-dependent group included the duration of lasting alcohol drinking and the intensity of withdrawal symptoms according to the CIWA- Ar scale. 3. According to the preference of alcohol type, a higher frequency of hypoglycemia was confirmed only in persons preferring to drink vodka.

Glucagon-like peptide-1 receptor imaging with [Lys40(Ahx-HYNIC- 99mTc/EDDA)NH2]-exendin-4 for the detection of insulinoma.

PURPOSE: The objective of this article is to present a new method for the diagnosis of insulinoma with the use of [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4. METHODS: Studies were performed in 11 patients with negative results of all available non-isotopic diagnostic methods (8 with symptoms of insulinoma, 2 with malignant insulinoma and 1 with nesidioblastosis). In all patients glucagon-like peptide-1 (GLP-1) receptor imaging (whole-body and single photon emission computed tomography/CT examinations) after the injection of 740 MBq of the tracer was performed. RESULTS: Both sensitivity and specificity of GLP-1 receptor imaging were assessed to be 100 % in patients with benign insulinoma. In all eight cases with suspicion of insulinoma a focal uptake in the pancreas was found. In six patients surgical excision of the tumour was performed (type G1 tumours were confirmed histopathologically). In one patient surgical treatment is planned. One patient was disqualified from surgery. In one case with malignant insulinoma pathological accumulation of the tracer was found only in the region of local recurrence. The GLP-1 study was negative in the other malignant insulinoma patient. In one case with suspicion of nesidioblastosis, a focal accumulation of the tracer was observed and histopathology revealed coexistence of insulinoma and nesidioblastosis. CONCLUSION: [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4 seems to be a promising diagnostic tool in the localization of small insulinoma tumours, but requires verification in a larger series of patients.

[Introduction to human genome sequencing in diagnostics]. / Wprowadzenie do sekwencjonowania ludzkiego genomu w diagnostyce.

The increasing efficiency of genetic analyzers together with the decreasing price of DNA sequencing per single nucleotide read, makes the method of individual genomes sequencing more available for diagnostic laboratories. Nowadays genome sequencing applications are predominantly used for research purposes but in nearest future we will be using them in routine patient evaluation as we are using analytic approaches based on Sanger method now. New generation sequencing is a tool which gives the researchers excellent possibilities for the realization of personalized medicine assumptions. However, before we will be able to make full use of it, there are still some questions to be answered, as for example who should perform the analysis, interpret results and finally who should be responsible for data management.

A patient with advanced breast cancer and hyperthyroidism associated with struma ovarii.

Not required for Clical Vignettes.

Imaging of inflamed carotid artery atherosclerotic plaques with the use of 99mTc-HYNIC-IL-2 scintigraphy in end-stage renal disease patients.

PURPOSE: Identification of vulnerable plaques remains crucial for better cardiovascular risk assessment. At least 20% of inflammatory cells within unstable (vulnerable) plaques comprise T lymphocytes, which contain receptors for interleukin-2 (IL-2); those receptors can be identified by scintigraphy with radiolabelled IL-2.The aim of this study was to identify the "inflamed" (vulnerable) plaques by scintigraphy using IL-2 labelled with (99m)Tc in the selected, high cardiovascular risk group of end-stage renal disease (ESRD) patients. METHODS: A total of 28 patients (18 men, 10 women, aged 55.2 ± 9.6 years, 17 on peritoneal dialysis, 11 on haemodialysis) underwent common carotid artery (CCA) scintigraphy with the use of (99m)Tc-hydrazinonicotinamide (HYNIC)-IL-2. In all cases, ultrasound examination of the CCA was performed and levels of selected proinflammatory factors, atherogenic markers and calcium-phosphate balance parameters were measured. Finally, the target to non-target (T/nT) ratio of IL-2 uptake in atherosclerotic plaques with intima-media thickness (IMT), classic cardiovascular risk factors and concentrations of the measured factors were compared. RESULTS: Increased (99m)Tc-HYNIC-IL-2 uptake in atherosclerotic plaques in 38/41 (91%) cases was detected. The median T/nT ratio of focal (99m)Tc-HYNIC-IL-2 uptake in atherosclerotic plaques was 2.35 (range 1.23-3.63). The mean IMT value on the side of plaques assessed by scintigraphy was 0.79 ± 0.18 mm (median 0.8, range 0.5-1.275). Correlations between T/nT ratio and homocysteine (R = 0.22, p = 0.037), apolipoprotein B (apoB) (R = 0.31, p = 0.008), apoB to apoA-I ratio (R = 0.29, p = 0.012) and triglyceride concentration (R = 0.26, p = 0.021) were detected. A lower T/nT ratio in patients with better parameters of nutritional status (haemoglobin, albumin, adiponectin) in comparison with patients with worse nutritional parameters (3.20 ± 0.5 vs 2.16 ± 0.68, p = 0.025) was revealed as well as a difference between values of T/nT ratio in groups of patients with values of apoB, soluble CD40 ligand and asymmetric dimethylarginine above and below median (3.18 ± 0.52 vs 2.16 ± 0.68, p = 0.031). No statistically significant association was found between T/nT ratio and mean value of either IMT or classic cardiovascular risk factors. CONCLUSION: Scintigraphy with the use of (99m)Tc-HYNIC-IL-2 can be a tool for inflamed atherosclerotic (vulnerable) plaque visualization within CCA in ESRD patients. Quantitative results of carotid artery scintigraphy with (99m)Tc-HYNIC-IL-2 correlate with serum concentration of selected cardiovascular risk markers.

Factors connected with the female sex seem to play an important role in differentiated thyroid cancer.

AIM: The aim of the study was to analyze whether female sex hormones and other factors connected with the female sex could increase the risk of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: Ninety-nine patients with a mean age±SD of 40.5±5.9 years with DTC and 51 healthy women with a mean age of 36.52±8.3 years were examined. Gynecological and obstetric histories were taken and serum estradiol and progesterone levels were analyzed in all women. RESULTS: Patients with DTC had more frequent menstrual cycle disturbances, used hormone-containing medicines more frequently, were mulitiparous more frequently, had spontaneous miscarriages more frequently, and their duration of lactation was significantly shorter than in controls. The mean serum estradiol level±SD in women with DTC was significantly higher than in the controls, in the follicular phase 193.74±66.31 vs. 157.63±42.88 pmol/l and in the luteal phase 519±176.9 vs. 369±71.49 pmol/l. The mean serum progesterone level±SD was higher in the controls than in patients with DTC, in the follicular phase: 2.11±0.70 vs. 1.38±0.56 nmol/l and in the luteal phase 20.95±17.46 vs. 17.31±12.28 nmol/l. CONCLUSIONS: The results of these studies imply that estrogens may at least modify the proliferation of thyroid cancer cells. The sex hormones probably intensify the actions of other carcinogens as well.

Dietary patterns as risk factors of differentiated thyroid carcinoma.

UNLABELLED: Nutritional factors are known to be important in the development of different metabolic diseases. The history of nodular or diffuse goiter is closely related to risk of thyroid carcinoma. On account of the function of the thyroid gland, many studies focus on iodine intake. The aim of the study was to assess whether dietary patterns could be risk factors of differentiated thyroid carcinoma. MATERIAL/METHODS: The case-control study was based on a questionnaire, which included information about dietary patterns and was carried out on 284 patients comprising 30 males (mean age 58.4±13.7 years), and 254 females (mean age 52.1±13.8 years), as well as 345 randomly selected controls: 58 males (mean age 60.2±12 years) and 287 females (mean age 53.4±14.3 years) randomly selected from the Population Register and adjusted by age and gender to the group of TC. The main groups of nutritional products, i.e. starchy foods, meat, dairy products, vegetables, fruits, and beverages, were analyzed. RESULTS: Consumption of vegetables, fruits, saltwater fish and cottage cheese was significantly lower in patients with differentiated thyroid carcinoma than in controls, quite the contrary to starchy foods, especially white bread. CONCLUSIONS: Dietary patterns appear to modify the risk of thyroid carcinoma. A diet rich in vegetables and fruit, as well as saltwater fish (a source of iodine) and low-fat meat, could be an important protective factor.

[Different aspects of food consumed by contemporary people]. / Rózne oblicza zywnosci spozywanej przez wspólczesnego czlowieka.

In accordance with the expectations of contemporary people food is to be not only a source of nutritional components but also a mean of realization of new goals. The food is to help in good health and beauty maintaining, in shaping the desired body look, in improving physical condition, in stress reduction, in deleting the process of getting old. The food should prevent from some diseases such as diseases of cardiovascular system, gastrointestinal tract and immunological system. As a result of such needs a few groups of new products of nonconventional food were created: functional food, fortified food, dietary supplements, ergogenic aids for sportsmen, nutraceuticals. The aim of this article is to show both positive and negative aspects of consumption of new generation food, created in order to fulfill human needs and expectations.

[Assessment of alcohol drinking model declared by male citizens living in Kraków district - Podgórze]. / Analiza modelu spozycia alkoholu deklarowana przez mezczyzn mieszkajacych w dzielnicy Krakowa - Podgórzu.

The aim of this paper was the assessment of alcohol model in population of men living in big city. To achieve this target we used data concerning alcohol drinking model incorporated in questionnaire filled by men participants of the Multicentre Studies and Epidemiology of Diabetes conducted from 1998 to 2000, 35-75 years of age, living in the Podgórze district of the city of Kraków. Based on declared data involved drinking frequency and alcohol amount drunk in one sitting in population of 1074 men, 35-75 years of age, we determined that 46.7% participants used to drink more than 2 times weekly and 17.8% drinking alcohol every day or almost every day. Analysis of amount of drunk alcohol in one sitting shown that 81.4% participants use to drink more than 4 standard alcohol units in one sitting and 35% drunk more than 10 standard alcohol units per one sitting. Additionally, in subpopulation of men, 35-50 years of age, so it means at the peak of professional activity period, only 17.76% declared moderate model of alcohol drinking. This study helps to provide proper health services for alcohol addicted persons and induces to active seeking for persons with alcohol drinking problem. It is important not only from improvement of public health point of view but also for social and economic harm reductions followed by alcohol drinking.

[Symptoms and early diagnostic possibilities of pancreatic endocrine cells hyperplasia (nesidioblastosis)]. / Symptomatologia i mozliwosci wczesnej diagnostyki hiperplazji kom6rek dokrewnych trzustki (nesidioblastosis).

Nesidioplastosis in adults is one of a rare causes of hyperinsulinemic hypoglycemia. Symptoms include chronic or recurrent hypoglycemias, often with neurological signs. Due to the looses of consciousness with coexisting seizures, in many cases patients are treated on epilepsy. Right diagnosis is usually late established, when the damages in the central nervous system (CNS) are irreversible. Early diagnosis of the disease and appropriate treatment might help to avoid serious disability in these patients. The aim of the study was to asses modern diagnostics of the nesidioblastosis with an emphasis on the biochemical and hormonal tests and imaging modalities. Patients enrolled to the study were aged between 18 and 72 years of age, and had chronic or recurrent hypoglycemia caused by hyperinsulinemia. In all patients fasting glucose and fasting insulinemia tests were performed, as well as the fasting blood test or in the 24-hour profile tests. Several techniques were used including ultrasound (US), abdominal computer tomography (CT), in two patients magnetic resonance imaging, scintigraphy of somatostatin receptors in seven patients, and in two patients scintigraphy with glucagone-like peptide-1 (GLP-1) analogue-labeled marker was done. In the performed tests low values of the blood glucose were found, whereas insulin levels, however not adequate to the blood glucose, were nearly always within the normal range. In the standard imaging only in one patient tumor lesion in the pancreatic tail was revealed, though not confirmed in the intraoperative histology. In the scintigraphy examination with the somatostatin analogue in one patient slightly increased collection of the marker in whole pancreas was reported and in the other patient focal collection in the pancreatic tail was observed. Scintigraphy with GLP-1 analogue revealed focal collection of the marker in one case. Five patients were underwent surgical treatment. In the histopathology in all operated patients hyperplasia of the endocrine pancreatic cells with positive immuno. histochemic reaction on the insulin was found. In the three cases despite hyperplasia of pancreatic islets, small sizes insulinomas were detected as well. 1. The diagnosis of nesidioblastosis should be taken into consideration in all patients with unclear-cause hypoglycemias, in whom simultaneously insulin blood level is inadequate to the level of glucose. 2. Widely available imaging examinations: US, CT, MRI are useless in the diagnosis of nesidioblastosis. 3. Among the imaging methods in preoperative diagnostics of hypoglycemia with concomitant hyperinsulinemia somatostatin receptor scintigraphy seems to have specific, though limited role - it is valuable only in the severe, diffused lesions. 4. Recurrent hypoglycemias after 70% excision of the pancreas may indicate the possibility of coexistence of pancreatic islets hyperplasia and insulin secreting insulinoma.

Prevalence of Selected Single-Nucleotide Variants in Patients with Neuroendocrine Tumors-Potential Clinical Relevance.

INTRODUCTION: The genetic basis of neuroendocrine tumors (NETs), whose incidence is continuously increasing, is still not fully defined. The majority of NETs are sporadic, and only a small percentage occur as part of hereditary genetic syndromes. However, the associations of multiple genetic variants have been found as clinically relevant in several neoplasms. The aim of this study was to evaluate whether selected, literature-based genetic variants may have a potential role in NET susceptibility and clinical outcome in Polish patients. MATERIALS/METHODS: A total of 185 patients recruited from one clinical center were enrolled. In the first part of the study, the molecular analysis including four single-nucleotide variants (rs8005354 (DAD1, NM_001344 intronic T/C substitution), rs2069762 (T/G substitution in the promoter region of the IL2 NM_000586), rs3731198 (CDKN2A, NM_000077 intronic A/G substitution), and rs1800872 (C/A substitution in the promoter region of the IL10 NM_000572)) was performed in 107 participants (49 patients with NETs with different primary site NETs and a control group of 58 healthy adult volunteers). In the second stage, the same single-nucleotide polymorphisms (SNPs) were assessed in 127 patients with NET and analyzed in terms of clinical data (primary site, serum CgA concentration, and metastatic disease). RESULTS: The analysis of homozygotes revealed a statistically significant higher prevalence of TT homozygotes of variant rs3731198 in the control group (p = 0.0209). In NET patients, there was a statistically significant higher prevalence of GG homozygotes of variant rs1800872 (p = 0.003). There was a statistically significant correlation between the rs3731198 variant and lymph node metastases (p = 0.0038 with Bonferroni correction). CONCLUSIONS: Our study indicates that GG homozygotes of variant rs1800872 are more often observed in NET patients, while TT homozygotes of variant rs3731198 are less frequent in this group. The rs3731198 variant may be related to an increased risk of lymph node metastasis. Further, larger multicenter studies are warranted to evaluate the potential genetic factors of sporadic NETs.

Peptide receptor radionuclide therapy as a potential tool for neoadjuvant therapy in patients with inoperable neuroendocrine tumours (NETs).

PURPOSE: Neuroendocrine tumours (NET) are a heterogeneous group of neoplasms of diffuse neuroendocrine cells. Surgery is the main aim in the treatment of NETs, which becomes impossible in the case of large tumours or infiltration into other tissues and/or important blood vessels. Neoadjuvant therapy might be helpful in decreasing NET size also, leading us to the point where a tumour, previously considered inoperable, becomes operable. The aim of the study was to assess the usage of peptide receptor radionuclide therapy (PRRT) as a neoadjuvant treatment, enabling surgical intervention in primary inoperable NET. METHODS: Among 47 patients treated with PRRT, 6 patients were chosen with large, inoperable tumours, for whom enabling of complete surgical excision of the lesions might offer the prospect for a cure. Response to the therapy was assessed according to Response Evaluation Criteria In Solid Tumors (RECIST). RESULTS: The mean tumour size decreased from 6.9 (min. 3.1 cm, max. 9.6 cm) before therapy to 5.4 cm (min. 3.1 cm, max. 9.5 cm) after the treatment. According to RECIST, stabilization of the disease was observed in four and partial responses in two patients. In two patients, reduction of the tumour size enabled surgical intervention. CONCLUSION: (1) PRRT might be considered a neoadjuvant therapy in primary inoperable NETs. (2) According to RECIST, stabilization of the disease was observed in the majority of patients. (3) We suggest that not only tumour diameter changes, but also tumour volume and contrast enhancement changes in computed tomography should be taken into consideration in assessment of the response to the therapy. (4) Somatostatin receptor scintigraphy is an important tool for qualification of the radioisotope therapy and also for the assessment of the response to PRRT.

Factors connected with the female sex seem to play an important role in differentiated thyroid cancer.

AIM: The aim of the study was to analyze whether female sex hormones and other factors connected with the female sex could increase the risk of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: Ninety-nine patients with a mean age ± SD of 40.5 ± 5.9 years with DTC and 51 healthy women with a mean age of 36.52 ± 8.3 years were examined. Gynecological and obstetric histories were taken and serum estradiol and progesterone levels were analyzed in all women. RESULTS: Patients with DTC had more frequent menstrual cycle disturbances, used hormone-containing medicines more frequently, were mulitiparous more frequently, had spontaneous miscarriages more frequently, and their duration of lactation was significantly shorter than in controls. The mean serum estradiol level ± SD in women with DTC was significantly higher than that in the controls, in the follicular phase 193.74 ± 66.31 vs. 157.63 ± 42.88 pmol/L and in the luteal phase 519 ± 176.9 vs. 369 ± 71.49 pmol/L. The mean serum progesterone level ± SD was higher in the controls than in DTC patients in the follicular phase: 2.11 ± 0.70 vs. 1.38 ± 0.56 nmol/L; in the luteal phase: 20.95 ± 17.46 vs. 17.31 ± 12.28 nmol/L. CONCLUSIONS: The results of these studies imply that estrogens may at least modify the proliferation of thyroid cancer cells. The sex hormones probably intensify the actions of other carcinogens as well.

[Placenta endocrine function influence on fetal hypothalamo-hypophyseo-thyroid axis]. / Czynnosc endokrynna lozyska a os podwzgórzowo-przysadkowo-tarczycowa u plodu.

The conteporary views on the influence of placenta on the fetal hypothalamo-hypophyseo-thyroid axis has been given. The role of hCG, estrogens, deiodineses, transfereses and arylosulphateses has been presented. Transthyretin role has been mentioned.

[The risk assessment of lungs' apices injury in patients after radioactive iodine therapy due to hyperthyroidism]. / Ocena ryzyka uszkodzenia szczytów pluc u pacjentów po leczeniu radiojodem z powodu nadczynnosci tarczycy.

In the light of recent research data hypothesis on radioactive iodine therapy leading to inflammatory reaction in lungs' apices has lately gained wider acceptance among pulmonologists. The study published of late showed that in one female patient previously treated with radioiodine due to toxic multinodular goiter 99mTc-Tectreotide uptake was found in the lung apex. The aim of study was evaluation of the risk assessment of inflammatory reaction in lungs' apices among patients treated with radioactive iodine due to hyperthyroidism. The study was carried out in 15 female patients (mean age 75 years +/-10 years) with large toxic multinodular goiter and fine needle aspiration biopsy negative for malignancy and who did not qualify for thyreoidectomy. Mean radioactive iodine therapeutic dose used in the study was 940 MBq. Chest SPECT scan (99mTc-Tectreotide) was performed one year after radioiodine therapy. Trace uptake in lung apex has been noted only in one patient. In 14 out of 15 patients in the study tectreotide uptake has not been found in any lungs' apices. All of 15 patients became euthyroid six months after radioactive iodine therapy and had their thyroid gland shrinked. No significant correlation between inflammatory reaction in lung apices and radioiodine therapy in patients with hyperthyroidism and large multinodular goiter was found in conducted study.

[The role of thyroid antibodies in the pathogenesis of the infertility and miscarriage]. / Rola przeciwcial przeciwtarczycowych w potencjalnej przyczynie nieplodnosci i poronien.

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.

Graves' disease and exophthalmos - a mask for meningioma.

Not required for Clinical Vignette.

[The causes and consequences of the cellular death (apoptosis and necrosis) in the course of acute poisoning with carbon monoxide]. / Apoptoza i nekroza--przyczyny i skutki w przebiegu ostrego zatrucia tlenkiem wegla.

The flow cytometry is acquiring more and more clinical importance. Despite its wide application in diagnostics, it is not used commonly in the clinical toxicology. The goal of the current investigation was to evaluate the mechanism for cell death (apoptosis or necrosis) and its manifestation in circulating human lymphocytes exposed to toxic concentration of carbon monoxide (CO). Since the large subpopulation of leukocytes have undergone apoptosis the next step of the studies was to assess the mobilization of progenitor cells (CD 34+) occurring in the peripheral blood after CO intoxication. Data were compared with those of 25 healthy controls comparable in terms of age, gender and physical activity. The application of the method in clinical reasoning was also evaluated. Significantly increased apoptosis of the lymphocytes in research group compared to control individuals correlates with the poisoning severity but does not depend on hypoxia. Decreased number of leukocytes caused by the cytotoxic effect of CO, stimulates the release of the CD 34+ to the peripheral blood. Increased cell death seems to be the relevant mechanism in the pathophysiology of acute carbon monoxide poisoning--the delayed apoptosis as the consequence of the reoxygenation can influence the delayed neurological and cardiological sequelae in patients after acute CO poisoning. In order to improve the treatment and help choose best fitting therapy, there should be need to introduce the new diagnostic methods like flow cytometry or innovative imaging techniques to the standard diagnostics in clinical toxicology.