[Non-pharmacological treatment of hypertension in practice of primary care physicians]. / Niefarmakologiczne leczenie nadcisnienia tetniczego w praktyce lekarzy opieki podstawowej.

The role of non-pharmacological methods in prevention and treatment of hypertension is well documented. Weight in patients with overweight and obesity, sodium intake restriction and alcohol drinking limitation are especially effective in arterial pressure reduction. The aim of this questionnaire study was to evaluate the knowledge and skills in that field of physicians working in primary health care. The study was done with 91 physicians working in Warsaw District. All of them declared that they give instructions about life style to their patients with hypertension. In majority it was oral consultation (36 persons, 39%) or oral consultation with distribution of booklets or brochures (48 persons, 52%). Six physicians (7%) sent patients to specialist. Pharmacological treatment was started most often from the systolic pressure 160 mmHg (59 persons, 64%) and diastolic pressure 100 mmHg (39 persons, 42%). Non-pharmacological advice was given most often at systolic pressure above 140 mmHg (44 persons, 48%) and diastolic pressure above 90 mmHg (67 persons, 73%). Salt intake reduction was advised always or usually by 82 physicians (90%), alcohol drinking reduction by 77 persons (85%) and tobacco smoking cessation by 86 persons (95%). Regular physical activity was advised always or usually by 75 persons (82%). Evaluation of nutrition was done predominantly by asking a few not-formal questions (62 persons, 67%). Only 1 physical used daily diary of nutrition. Similarly in evaluation of physical activity 62 persons (67%) used only not-formal questions. It is worthily to note that 36 persons (40%) considered that they need more skills to give advices of healthy life style, 49 persons (53%) did not enough time to do that and 30 persons (33%) thought that it is hard to give advices they can't keep themselves. All questionnaire physicians declared to use non-pharmacological treatment in patients with hypertension. Quite good knowledge of essential recommendations in that field was stated. The results of this questionnaire indicate that many physicians estimate their knowledge and skills as low in that sphere.

Comparative analysis of plasma lipoprotein components assessed by ultracentrifugation in primary biliary cirrhosis and chronic hepatitis.

UNLABELLED: The evaluation of lipid and lipoprotein profiles in liver diseases has important cognitive aspects and provides practical information contributing to the diagnosis of liver pathology. There are few studies of this problem using the ultracentrifugation method. AIM OF THE STUDY: A comparison of lipid profile (obtained by plasma ultracentrifugation) in patients with primary biliary cirrhosis (PBC) and chronic hepatitis (CH). MATERIAL AND METHODS: 103 percutaneous liver biopsies were routinely performed from 1994 to 1997. Blood samples were taken from all the patients at the time of biopsy for further evaluation of lipid profile. 15 patients with PBC and 15 patients with CH (of HBV or/and HCV etiology) were studied. RESULTS: In patients with CH mean total, esterified and free cholesterol levels (166 mg%, 117.6 mg% and 48.1 mg%, respectively) were significantly lower (p < 0.002; p < 0.004; p < 0.006, respectively) than in patients with PBC (237.5 mg%, 165.7 mg% and 71.8 mg%, respectively). The phospholipid concentration in sera of patients with PBC were significantly higher (271.1 mg%, p < 0.0004) than in patients with CH (187.6 mg%), whereas apolipoprotein B and apoAII were significantly lower. Total, esterified and free cholesterol levels in LDL fraction were significantly higher in patients with PBC (175.3 mg%, p < 0.007; 117.9 mg%, p < 0.02; 57.6 mg%, p < 0.01, respectively) than in patients with CH (113.7 mg%, 78.7 mg% and 35 mg%, respectively). The concentration of phospholipids in LDL fraction in patients with PBC was significantly higher (166.8 mg%; p < 0.003) in comparison with patients with CH (96.3 mg%). The differences in other lipoprotein fractions (VLDL and HDL) were not statistically significant. CONCLUSIONS: High levels of total, free and esterified cholesterol as well as phospholipids, apolipoprotein B and AII were observed by us in patients with PBC in comparison with patients suffering from CH. The increase of cholesterol (total, esterified and free) and the phospholipid concentration in serum, are a manifestation of their higher concentration in LDL fraction.

[Liver steatosis assessed by ultrasonographic examination in patients with hyperlipoproteinemia]. / Stluszczenie watroby oceniane badaniem ultrasonograficznym u osób z hiperlipoproteinemia.

Ultrasonographic examinations were carried out in 174 patients with various types of hyperlipoproteinaemia, determining the incidence of the features of liver steatosis. In the group of 77 patients with hypercholesterolaemia (TCH > 200 mg%) the features of liver steatosis occurred in 13 cases (16.9%). In 90 patients with mixed hyperlipidaemia (TCH > 200 mg%, TG > 2.3 mmol/l) the features of liver steatosis were found in 50% of cases. Both in the groups of patients with hypercholesterolaemia and with mixed HLP, the patients with liver steatosis had significantly higher body mass index. In the group of patients with hypercholesterolaemia (without and with the features of liver steatosis) no differences were found in the concentrations of total cholesterol (TCH), triglycerides (TG) and high density lipoprotein fraction (HDL). In the patients with mixed HLP and the features of liver steatosis in USG examination, the mean serum triglyceride concentration was 6.2 mmol/l and was almost twice higher than that in the group without steatosis. The serum HDL concentration in the patients with mixed HLP was 39.2 mg% and was significantly lower than that in the patients with the same type of lipid concentration disturbances but without liver steatosis (48.2 mg%). The total serum cholesterol concentration was not differing significantly between the patients with liver steatosis and those without this pathological condition.

[Fatty liver assessed by histologic examination in patients with hyperlipoproteinemia]. / Stluszczenie watroby oceniane badaniem histologicznym u osób z hiperlipoproteinemia.

Out of 665 patients after liver biopsy performed during 14 years of the work of the Clinic, 35 cases of patients with non-alcoholic liver steatosis and hyperlipoproteinaemia were selected and analysed retrospectively. The cases of patients with the presence of HBV or HCV infection markers were excluded. The histological material was divided according to the intensity of steatosis expressed as the per cent of hepatocytes with the features of fatty degeneration and also according to the following classification: I--steatosis, II--steatosis with hepatitis, III--steatosis with portal fibrosis, IV--steatotic cirrhosis. In the patients in whom the per cent of hepatocytes with fatty degeneration in biopsy examination exceeded 60%, the mean serum triglyceride concentration was 5.53 mmol/l and was over twice higher than that in the group with steatosis not exceeding 30% of hepatocytes. Similarly, in the patients with steatosis and accompanying hepatitis (steatohepatitis), the mean triglyceride concentration was 5.28 mmol/l and was over twice higher than that in the patients with steatosis with accompanying portal fibrosis. The patients with steatohepatitis had significantly lower HDL concentrations than those with the remaining types of histological changes.

Natural history of peptic ulcer disease in Poland. Part VIII. Peptic ulcer disease and diseases of the liver, bile ducts and gallbladder.

The data obtained from the databank Ulcer showed that among 5813 patients with peptic ulcer 472 (8.11%) had concomitant liver diseases, and 540 (9.28%) had concomitant disease of the bile ducts. A detailed analysis of the data confirmed the presence of symptoms and signs known to occur in these diseases.