The association between macroprolactin levels and vitamin D status in premenopausal women with macroprolactinemia: a pilot study.

BACKGROUND: Macroprolactinemia is a frequent cause of misdiagnosis and mismanagement of patients with elevated prolactin levels. Its pathogenesis and clinical significance are still controversial. METHODS: The aim of this study was to investigate the relationship between elevated macroprolactin content and vitamin D status. The study population included 20 premenopausal women with isolated macroprolactinemia, 10 of whom were later treated with vitamin D (2 000 IU daily). Serum prolactin, macroprolactin, 25-hydroxyvitamin D and PTH levels were assessed at baseline and after 4 months of treatment. RESULTS: Compared with the control age- and weight-women with normal prolactin levels (n=11), patients with macroprolactinemia were characterized by lower levels of 25-hydroxyvitamin D and slightly higher levels of PTH. Vitamin D administered to patients with macroprolactinemia increased 25-hydroxyvitamin, reduced total prolactin and macroprolactin, as well tended to reduce PTH. The effect of vitamin D on total prolactin and macroprolactin correlated with their baseline values and baseline 25-hydroxyvitamin D levels. CONCLUSIONS: The results of our study suggest the association between vitamin D status and elevated macroprolactin levels in premenopausal women.

Diagnosis of gastroesophageal reflux and anti-reflux procedures among Polish children with gastrostomies: a 10-year nationwide analysis.

BACKGROUND/OBJECTIVES: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. SUBJECTS/METHODS: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. RESULTS: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. CONCLUSIONS: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children.

Physical and emotional disturbances in children with adenotonsillar hypertrophy.

OBJECTIVE: Enlarged tonsils and adenoids (part of Waldeyer's ring) are responsible for obstructive sleep disordered breathing. Obstructive sleep disordered breathing episodes lead to hypoxaemia, hypercapnia and a state of arousal, all of which affect normal development of the nervous system. In this study, two hypotheses were tested: (1) obstructive sleep disordered breathing is caused by adenotonsillar hypertrophy and is associated with hypoxia and brain dysfunction; and (2) children with obstructive sleep disordered breathing more commonly display emotional lability, depressive behaviour and anxiety. MATERIAL AND METHODS: A total of 225 children were examined. The study group consisted of 121 children with adenotonsillar hypertrophy (87 aged six to nine years and 34 aged 10 to 13 years) and with obstructive sleep apnoeas and hypopnoeas confirmed by polysomnography. Patients were compared with 104 children with no obstructive sleep disordered breathing and no adenotonsillar hypertrophy (74 aged six to nine years and 30 aged 10 to 13 years). The following tests were used to measure the children's emotional disorders: the children's depression inventory; the state-trait anxiety inventory for children; and the emotional instability scale. The average values and standard deviations were calculated for all results. Student's t-test was used to compare differences in all groups of children. The minimum level of p < 0.05 was set as statistically significant. RESULTS: Children with adenotonsillar hypertrophy are more likely to experience poor brain development and sleep problems. They also have emotional disturbances. In the sick and healthy children aged six to nine years, mean results for the emotional instability scale were statistically significantly different in the two groups, being higher in children with adenotonsillar hypertrophy than in healthy children. Mean values for the children's depression inventory test were higher in children with adenotonsillar hypertrophy, but the differences were not statistically significant. In the state-trait anxiety inventory for children test, the mean T score was T = 1.760 and the level of significance was p = 0.08 for both groups. Since the standard level of significance was p < 0.05, the differences in mean values for the state-trait anxiety inventory for children test bordered on statistical significance. There were no differences between tests results in the older children (10 to 13 years). CONCLUSIONS: Recent studies have confirmed the negative emotional effect of adenotonsillar hypertrophy induced obstructive sleep disordered breathing in children aged six to nine years. The main problems are emotional lability, and anxiety and depressive disturbances. Such emotional problems subside in older children (aged 10 to 13 years).

[Effect of vitamin/mineral supplementation on calcium, magnesium and iron levels in amniotic fluid and serum taken from women during first half of pregnancy]. / Ocena wplywu suplementacji witaminowo-mineralowej na stezenia magnezu, zelaza i wapnia w plynie owodniowym i surowicy krwi ciezarnych w I polowie ciazy.

The levels of calcium, magnesium and iron in amniotic fluid and serum taken from women during first half of pregnancy were compared. The relationship between these levels and vitamin-mineral supplementation was also estimated. There was similar calcium and magnesium concentration in the serum and amniotic fluid. The concentration of iron in serum was four times as large as in amniotic fluid. Any influence of supplementation on concentration of studied minerals was noted.

[Laryngeal carcinoma in brothers]. / Rak krtani u braci.

The most important etiologic factors of laryngeal carcinoma are tobacco smoking and heavy drinking as well as precancerous changes of laryngeal mucosa. The significance of genetic or family factor is still not explained. Two brothers, 45 and 48 years old, in which supraglottic carcinomas were diagnosed, are presented. The tumor localisation was the same in both brothers. In each of the patients supraglottic horizontal laryngectomy and neck dissection were performed. In one brother 5-year disease free survival was obtained, in second the distant and regional metastases were cause of death after two years.

[Extracapsular spread of lymph nodes as a prognostic factor in laryngeal carcinoma]. / Naciek zewnatrztorebkowy wezlów chlonnych z przerzutami jako czynnik rokowniczy w raku krtani.

The authors analysed clinical and morphological data of 105 patients with laryngeal carcinoma metastases in cervical lymph nodes treated in Department of Otolaryngology Medical University of Gdansk in the years 1976-1985. The incidence of extracapsular spread and its relation to certain features of primary tumor and regional lymph nodes were estimated. The authors presented treatment results in two group of patients--with and without presence of extracapsular spread and stated prognostic value of extracapsular spread in patients with laryngeal carcinoma.

[Bilateral neck dissections]. / Obustronne operacje wezlowe szyjne.

The structure of lymphatic system of the larynx causes that in some cases node metastases may occur bilaterally. In many patients bilateral neck dissection is indicated. In material of 252 patients with laryngeal carcinoma, treated in ENT Department in Gdansk in 1976-1985, an assessment of frequency and indications to one-stage bilateral neck dissection was made. Among 252 patients, bilateral operations were performed in 50, i.e. 20%. We have found that in 29 patients of 50 were nodal metastases, in 12 unilateral and in 17 bilateral. The analysis of long-term results of treatment showed 23.5% of 5-year survivals in patients with bilateral metastases and 42.3% in patients with unilateral metastases. To base on these data we consider that bilateral one-stage neck dissection should be a standard treatment in many cases of laryngeal carcinoma.

[Effectiveness of elective neck dissection in patients with laryngeal carcinoma]. / Ocena skutecznosci elektywnej operacji wezlowej na szyi u chorych na raka krtani.

The authors presented material of 711 patients with laryngeal cancer treated in Department of Otolaryngology Medical University of Gdansk in the years 1976-1995 estimating effectiveness of elective neck dissection. 402 patients (56.6%) had N0 stage and in 162 of them elective neck dissection was performed. Occult metastases were found in 21% of N0 patients. Comparing treatment results in this group to inoperated N0 patients the authors found higher percentage of survival and lower incidence of failure after elective neck dissection.

[Long term result of treatment of laryngeal carcinoma (1981-1990)]. / Odlegle wyniki leczenia raka krtani (1981-1990).

Long term results were evaluated on the basis of the epidemiological and clinical analysis of 386 patients treated surgically because of squamous cell carcinoma of the larynx in the ENT Department, Medical University of Gdansk between 1981-1990. Full recovery was achieved in 52.3% of patients, failure was found in 26.9%. In the treatment evaluation the following factors were taken into account: the age of patients, T and N classification and clinical staging, primary location of the tumour. The treatment results, concerning the years 1981-1990 were compared to the ones obtained in our clinic in 1971-1980; it has been stated that the differences between the percentage of recoveries and the failures are statistically unimportant.

[Meningiomas of the nose and paranasal sinuses]. / Oponiaki nosa i zatok przynosowych.

In material of ENT Department, Medical University of Gdansk we have three cases of extracranial meningioma localized in the nose and sinuses. Two of them are presented in this paper. One case was 29 year woman with meningioma of the nose and ethmoid and maxillary sinuses; it was residual tumor after removal of intracranial meningioma 3 years earlier. Second case was 14 year boy with meningioma of the nose, ethmoid and maxillary sinuses and of the orbit. In both patients tumor was removed by rhinosurgical access (lateral rhinotomy). Late results of the operation were very good. Basing on clinical and radiological pictures of both cases, pathological characteristics of naso-sinusal meningioma was made.

[Evaluation of treatment and preventive care for recurrent urolithiasis in children]. / Ocena skutecznosci leczenia i profilaktyki kamicy nawrotowej ukladu moczowego u dzieci.

Among 425 children with urolithiasis treated in the Paediatric Clinical Department of the National Research Institute of Mother and Child in Warsaw between 1976-1997, 50 of them i.e. 11.7% (26 boys and 24 girls) had recurrent urolithiasis. Patients' age was from 10 months to 16 years and 5 months. The number of recurrences of uroliothiasis before treatment in the Institute was from 1 to 8. Most of the children had numerous surgical operations, some of them excreted stones spontaneously. The etiology was determined in all cases. A metabolic cause of urolithiasis was found in 34 cases, i.e. 68% of the analysed group. They were as follows: idiopathic hypercalcuria--24 cases, uric acid urolithiasis--5 cases, cystynuria--4 cases, and incomplete distal renal tubular acidosis--1 case. Other reasons for urolithiasis were: infection--7 cases, idiopathic urolithiasis--8 cases, ren spongiosum--1 case. Prevention of recurrences depending on the etiology was successful. In 45 cases no recurrences were found. Recurrent urolithiasis was observed in 4 cases of cystynuria and in one case of incomplete tubular acidosis. The observation period was from 3-19 years.

[Pathological and clinical assessment of polypoid hypertrophy of the vocal cords]. / Polipowaty przerost faldów glosowych. Patologia i klinika.

Polypoid hypertrophy of mucosa of the vocal cord is the most common non-neoplastic disease of the larynx. This hypertrophy has a form of simple polyp of vocal cord or polypoid hypertrophy of the whole length of one or both vocal cords. In most cases a course of the disease is typical. In a few cases we can observe changes in polyp epithelium, i.e. hyperplasia or even dysplasia. Clinical and histological analysis of 809 patients treated because of laryngeal polyps (by Kleinsasser microsurgical procedure) within the period of 1981-1995 at ENT Clinic in Gdansk was made. Sex and age of the patients, macroscopic picture of the disease as well as treatment and results were assessed. Special attention was paid to the problem of polyp epithelium rebuilding. In a few cases, polyp of the vocal cord should be assessed as praecancerous state.

[Ocular and orbital symptoms of Wegener's disease]. / Oczne i oczodolowe objawy choroby Wegenera.

Wegener's granuloma occurs most commonly in upper respiratory tract, in lungs and in kidneys. In many cases ocular and orbital disturbances may be accompanied by changes in the nose and sinuses. These disturbances occur as: superior orbital fissure syndrome, orbital apex syndrome or ocular fascicle atrophy. The authors present the symptoms of these disturbances in 3 patients treated at Otolaryngological Clinic, Medical University of Gdansk. On the bases of clinical symptoms and radiological results (CT and MRI) the assessment of pathogenesis of ocular and orbital symptoms was made in each of these cases, with special regard to the mode and result of the treatment.

[Extramedullary plasmacytomas of the larynx]. / Odosobnione pozaszpikowe guzy plazmatycznokomórkowe krtani.

The authors present four cases of solitary extramedullary plasmocytoma of the larynx, a very rare laryngeal tumor, seen in ENT Department, Medical University of Gdansk in years 1948-1994. They were 0.16% of all malignant laryngeal neoplasms and 23.5% of non-epithelial neoplasms of the larynx in this period. Characteristics for these tumors, epidemiological and clinical features were discussed.

[Partial surgery in treatment of laryngeal cancer in the material of ENT department in Gdansk]. / Operacje czesciowe w raku krtani w materiale Kliniki Gdanskiej.

Partial operations in treatment of laryngeal cancer in 112 patients was presented. This material was divided on two groups: 14 patients with supraglottic cancer and 98 patients with glottic cancer. Types of operations, their results and failures of treatment was presented and discussed. Special attention was paid to the problem of vocal cord mobility in qualification of the patients to partial operations of the larynx.

[A case of giant cell tumor of the temporal bone and the region of the temporomandibular joint]. / Przypadek guza olbrzymiokomórkowego kosci skroniowej i okolicy stawu skroniowo-zuchwowego.

The giant-cell tumor in temporo-mandibular joint region and of temporal bone in 38 years old woman was described. The CO60 therapy was recommended with any success in tumor regression.