The effect of alfacalcidiol and metformin on phenotype manifestations in women with polycystic ovary syndrome - a preliminary study.

Aim of this study was to evaluate the effect of vitamin D supplementation in obese, insulin resistant and vitamin D deficient PCOS women on biochemical and clinical hyperandrogenism and menstrual irregularity in comparison to effect of metformin or combined metformin plus vitamin D therapy. Thirty nine PCOS women were randomized into three groups and treated with alfacalcidiol (Group 1), combined alfacalcidiol and metformin therapy (Group 2) and metformin (Group 3) for 6 months. Serum TST, fTST, DHEAS, LH and LH/FSH were measured before and after six months of treatment. Menstrual cycle regularity, hirsutism, acne and pregnancy rate were assessed at the same time. There was a significant decrease in TST levels in the Group 2 and slight but not significant decrease in the Group 3. No significant changes in other parameters (fTST, DHEAS, LH, LH/FSH) have been found after 6 months therapy in all three groups. An improvement of menstrual cycle was detected in 78 % of patients in Group 1 (p<0.04), 80 % in the Group 2 (p<0.03) and in 90 % in the Group 3 (p<0.002), respectively. There was no significant improvement of acne and hirsutism in all three groups (all p not significant). Pregnancy rate was higher in the Group 3 as compared with Groups 1 and 2 (67 % vs. 0 % and 25 %, respectively), however without statistical significance. Vitamin D administration has no significant effect on androgen levels and clinical features of hyperandrogenism in obese vitamin D deficient PCOS women. However, it can potentiate effect of metformin on testosterone levels and LH/FSH ratio but not on clinical hyperandrogenism and pregnancy rate.

[Is polycystic ovary syndrome associated with autoimmune thyroiditis?]. / Je syndróm polycystických ovárií asociovaný s autoimunitnou tyreoiditídou?

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women of fertile age and lately there is a discussion about its possible association with autoimmune diseases. The aim of the study was to examine incidence of autoimmune thyreoiditis (AIT) in PCOS women. PATIENTS AND METHODS: 64 PCOS patients were enrolled and 68 healthy menstruating women served as controls. All subjects were examined for thyrotropin (TSH), free thyroxin (fT4) and the presence as well as titers of antithyroid antibodies aTG (anti-thyreoglobulin) and aTPO (anti-thyreoperoxidase). RESULTS: There was no difference between PCOS and controls in average TSH levels (2.37 ± 1.46 mIU/l vs 2.37 ± 1.46 mIU/l) (p = 0.953), and fT4 levels (16.36 ± 5.34 pmol/l vs 16.49 ± 2.32 pmol/l) (p = 0.852). Autoantibodies titers were also non-significant aTG (53.09 ± 157.07 IU/ml vs 29.8 ± 100.77 IU/ml, p = 0.386) and aTPO (59.74 ± 149.03 IU/ml vs 45 ± 204.77 IU/ml, p = 0.805). However, PCOS women had significantly higher prevalence of aTPO (18.75 vs 7.35%, p = 0.045). On the other hand, the overall prevalence of AIT was similar in both groups. CONCLUSION: Our results show PCOS patients have slightly but significantly higher positivity of aTPO antibodies but the prevalence of AIT was insignificant.

[Polycystic ovary syndrome and autoimmune diseases]. / Syndróm polycystických ovárií a autoimunitné ochorenia.

Polycystic ovary syndrome (PCOS) is characterized by laboratory or clinical signs of hyperandrogenism with chronic anovulation and is currently one of the most frequent endocrinopaties in women of fertile age. Syndrome is associated with a variety of endocrine and metabolic disturbances and according to results of scientific work could be possibly associated with some autoimmune diseases. It seems that the prevalence of autoimmune tyroiditis is important among these patients. Recent studies reveal higher incidence of organ - non specific autoantibodies, but their clinical significance is unknown to date. Further studies are required to determine the role of organ specific and non-specific autoantibodies in patients with PCOS. According to determine an etiology of the syndrome one of the possible outcomes could be investigation of anti-follicular antibody.

Echocardiography in sarcoidosis.

We examined 39 patients with biopsy proven sarcoidosis of the lungs by one-dimensional, two-dimensional and pulsed Doppler echocardiography. In 18 (46.2%) we revealed a prolapse of one or both cusps of the mitral valve which can partly explain some of the complaints and objective findings in these patients (palpitations, chest pain, changes on ECG resembling myocardial infarctions, murmurs, etc.). A minor pericardial effusion was present in 8 (20.5%) of the patients. The finding of reduced systolic thickening and excursions of the interventricular septum in 4 (10.2%) may be related to the frequent prevalence of sarcoid granulomas in the septum. Asymmetric septal hypertrophy, recorded in 4 (10.2%) patients, may have had a similar origin. Administration of corticosteroids did not influence in a significant way any of the echocardiographic indicators nor the amount of pericardial effusion. In patients with palpitations and extrasystolic arrhythmias, however, the extrasystoles disappeared and the patients reported subjective relief in all instances.

Bronchial vascularization in patients with bronchiectasis.

An analysis of the angiographic patterns of bronchial vascularization in 22 patients with bronchiectasis is presented. The studies disclosed three types of angiographic patterns: (1) bronchial hypervascularization alone; (2) bronchial hypervascularization associated with bronchopulmonary anastomoses, and (3) bronchial hypervascularization with plexiform enlargement of bronchial arteries, vascular collections or angiomatous structures. These types of angiographic pattern show a good correlation with the clinical features and supplment the global assessment of the extent and character of bronchiectasis. Selective bronchial arteriography is useful in patients with bronchiectasis where surgical treatment has been planned, especially if the disease is associated with hemoptysis.