Subclinical hypothyroidism and left ventricular mechanics: a three-dimensional speckle tracking study.

CONTEXT: Subclinical hypothyroidism (SHT) is associated with left ventricular (LV) remodeling. The LV mechanics has not been previously assessed by two- and three-dimensional (2DE and 3DE) speckle tracking imaging in the SHT patients. OBJECTIVES: The objective of the study was to investigate LV mechanics by 2DE and 3DE speckle tracking in the SHT patients and evaluate the influence of levothyroxine therapy on LV remodeling. DESIGN: We conducted a prospective study. All SHT patients received levothyroxine therapy and were followed up for 1 year after the euthyroid state had been achieved. SETTING: The study was performed at a university hospital. PATIENTS: We included 54 untreated women with SHT and 40 healthy control women who were of similar age. MAIN OUTCOME MEASURES: The 2DE strain and strain rates, 3DE volumes, 3DE strain, and thyroid hormones levels were assessed. RESULTS: The 2DE LV longitudinal and circumferential strain and systolic and early diastolic strain rates were significantly decreased in the SHT patients before therapy in comparison with the controls or the SHT patients after therapy. The 3DE LV cardiac output and ejection fraction were significantly reduced in the SHT patients at baseline compared with the controls or patients after 1 year of treatment. The 3DE LV longitudinal and radial strains were significantly lower in the SHT group before treatment in comparison with the controls or patients after therapy, whereas the 3DE LV circumferential and area strains gradually increased from untreated SHT patients, among the treated SHT patients, to the controls. CONCLUSION: SHT significantly affects LV deformation assessed by 2DE and 3DE speckle tracking. The improvement of LV mechanics after 1 year of levothyroxine treatment is significant but incomplete.

Heart rate variability and increased risk for developing type 2 diabetes mellitus.

BACKGROUND/AIM: To our knowledge there are no data about the relationship between elevated risk for developing type 2 diabetes mellitus (DM2) and altered cardiac autonomic function. The aim of this study was to evaluate the association between heart rate variability (HRV) and slightly increased risk for DM2. METHODS: We evaluated 69 subjects (50.0 ± 14.4 years; 30 male) without DM2, coronary artery disease and arrhythmias. The subjects were divided into two groups according to the Finnish Diabetes Risk Score (FINDRISC): group I (n = 39) included subjects with 12 > FINDRISC ≥ 7; group II (n = 30) subjects with FINDRISC < 7. HRV was derived from 24-h electrocardiogram. We used time domain variables and frequency domain analysis performed over the entire 24-h period, during the day (06-22 h) and overnight (22-06 h). RESULTS: Standard deviation of the average normal RR intervals was significantly lower in the group with increased risk for DM2 compared to the group II (127.1 ± 26.6 ms vs 149.6 ± 57.6 ms; p = 0.035). Other time domain measures were similar in both groups. The group I demonstrated significantly reduced frequency domain measures, total power--TP (7.2 ± 0.3 ln/ms2 vs 7.3 ± 0.3 ln/ms2; p = 0.029), and low frequency--LF (5.9 ± 0.4 ln/ms2 vs 6.3 ± 0.6 In/ms2; p = 0.006), over entire 24 h, as well as TP (7.1 ± 0.3 In/ms2 vs 7.3 ± 0.3 In/ms2; p = 0.004), very low frequency (6.2 ± 0.2 In/ms2 vs 6.3 ± 0.2 In/ms2; p = 0.030), LF (5.9 ± 0.4 In/ms2 vs 6.2 ± 0.3 In/ms2; p = 0.000) and high frequency (5.7 ± 0.4 In/ms2 vs 5.9 ± 0.4 In/ms2; p = 0.011) during the daytime compared to the group II. Nocturnal frequency domain analysis was similar between the groups. The low diurnal frequency was independently related to elevated risk for diabetes mellitus (beta = -0,331; p = 0.006). CONCLUSION: The obtained results suggest that even slightly elevated risk for developing diabetes mellitus may be related to impaired HRV.

Left and right ventricular structure and function in subclinical hypothyroidism: the effects of one-year levothyroxine treatment.

BACKGROUND: The aim of this study was to investigate left ventricular (LV) and right ventricular (RV) structure, function, and mechanics in patients with subclinical hypothyroidism (SHT), and to evaluate the effect of a 1-year levothyroxine treatment. MATERIAL AND METHODS: We compared 45 untreated women with subclinical hypothyroidism and 35 healthy control women matched by age. All the subjects underwent laboratory analyses, which included a thyroid hormone levels (free T3, free T4, and TSH) test, and a complete 2-dimensional echocardiographic study. All the SHT patients received levothyroxine therapy and were followed for a year after euthyroid state was achieved. RESULTS: The LV mass index in the SHT participants before and after replacement therapy was significantly higher than in controls. In the SHT patients before the treatment, LV diastolic function and global function estimated by the Tei index were significantly impaired, whereas the LV systolic function was decreased. The results show that LV mechanics was significantly impaired in the SHT patients at baseline. Additionally, the SHT participants before levothyroxine substitution had increased RV wall thickness and significantly impaired RV diastolic and global function in comparison with the controls or the SHT subjects after the treatment. Furthermore, RV mechanics was also significantly deteriorated in the SHT patients before the treatment. CONCLUSIONS: Subclinical hypothyroidism significantly affected LV and RV structure, systolic, diastolic and global function, and LV and RV mechanics. Levothyroxine replacement therapy significantly improved cardiac structure, function, and mechanics in the SHT patients.

Feasibility of semi-quantitative assessment of left ventricular contractile reserve in dilated cardiomyopathy.

BACKGROUND: We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high-dose dobutamine stress-echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy. PURPOSE: To assess the feasibility of semi-quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy. METHODS: High-dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%. LVEF was calculated 1) using Simpson's biplane formula, and 2) semi-quantitatively (5% increments) by novice and experienced echocardiographers, and by a DSE expert. Patients were considered to have preserved LV contractile reserve if LVEF dobutamine-induced change was ≥5%. RESULTS: Twenty-seven (45.8%) patients died during the 5-year follow-up. The feasibility of the assessment was 89%, 94%, and 98% for novice and experienced readers and DSE expert, respectively. Kaplan-Meier analysis showed that LV contractile reserve assessed semi-quantitatively by DSE expert and experienced reader achieved the best prognostic separation (log rank 19.63 and 18.99, respectively, p < 0.001 for both), followed by quantitative assessment (log rank 9.76, p = 0.0018) and assessment by novice reader (log rank 8.76, p = 0.012). Areas under the curves were similar for quantitative and semi-quantitative assessment of LV contractile reserve. CONCLUSIONS: Our data indicate that semi-quantitative assessment of LV contractile reserve is feasible by differently skilled operators.

[Myocardial performance index: prediction and monitoring of remodeling and functioning of the left ventricle after first myocardial infarction].

INTRODUCTION: Dynamic changing of left ventricular geometry and contractile state after acute myocardial infarction is responsible for various aspects of left ventricular remodeling and dysfunction. A number of studies have shown that myocardial performance index allows prediction of acute myocardial infarction complications. The objective of our study was to determine the power of myocardial performance index to predict and assess the severity of left ventricular remodeling, systolic and diastolic dysfunction after acute myocardial infarction over the long term. MATERIAL AND METHODS: Echocardiography was performed within the first week of hospitalization, after one, three and six months in 77 patients with first acute myocardial infarction. At the end of the study the patients were divided into group A and B with mild and severe left ventricular remodeling, respectively. RESULTS: Myocardial performance index was significantly lower in group A compared to B, at the beginning (0.62 vs. 0.75; p = 0.002), and at the end of study (0, 60 vs. 0, 69; p = 0.004). After six months, 31% of study patients developed LV systolic dysfunction with prevalence in group B (56% vs. 19%, p = 0.002). Myocardial performance index > or = 0.70 at first week after acute myocardial infarction is a strong predictive parameter for extensive early and late left ventricular remodeling and systolic dysfunction (p < 0.05), but it is not a valuable predictor of diastolic failure. DISCUSSION AND CONCLUSIONS: MPI obtained at first week of acute myocardial infarction was predictive for early and long term left ventricular remodeling and systolic dysfunction. Myocardial performance index had doubtful clinical use in assessing dynamics of remodeling and it was without clinical value in predicting diastolic function deterioration.

Impact of acute exercise on antioxidant enzymes activity and lipid status in blood of patients with hypertension.

BACKGROUND/AIM: Many studies support the hypothesis that oxidative stress is involved in the pathogenic process of a variety of diseases including hypertension. In humans, hypertension is also considered a state of oxidative stress that can contribute to the development of arteriosclerosis and other hypertension-induced organ damage. The aim of this study was to evaluate an influence of acute physical exercise on antioxidative enzymes activity and lipid status in patients with hypertension. METHODS: Fourty patients with hypertension and 20 age-matched controls were included in the study. To assess an influence of acute exercise on lipids and antioxidative enzymes activity the following parameters were determined at rest and immediately after the acute cardiopulmonary exercise cycloergometer test: triglycerides (TG), total cholesterol, low density cholesterol (LDL), oxidised LDL cholesterol (OxLDL), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and plasminogen activator inhibitor (PAI). RESULTS: In basal condition, hypertensive patients compared to the control group had increased, but not significantly, level of Ox LDL (88.61 +/- 14.06 vs 79.00 +/- 29.26 mmol/L), PAI (3.06 +/- 0.56 vs 2.6 +/- 0.35 U/mL) and activity of GSH-Px (50.22 +/- 15.20 vs 44.63 +/- 13.73 U/g Hb). After acute exercise test, there was significantly greater level of Ox LDL (79.0 +/- 29.26 vs 89.3 +/- 29.07 mmol/L; p < 0.05) only in the control group. GSH-Px activity was significantly decreased only in hypertensive patients after acute exercise (50.22 +/- 15.2 vs 42.82 +/- 13.42 U/g Hb; p < 0.05), but not in the controls. CONCLUSION: No significantly elevated Ox LDL, GSH-Px and PAI-1 levels were found in hypertensive patients during basal condition in comparison with healthy subjects. Decreased GSH-Px activity was associated with those in acute exercise only in hypertensive patients. It could be an important indicator of deficiency of physiological antioxidative defense mechanism in hypertensive patients during an acute exercise.

Clinical evaluation of oxidative stress in patients with diabetes mellitus type II -- impact of acute exercise.

BACKGROUND/AIM: Exercise is a well recognized model of oxidative stress and, also, an important tool in diabetes management. The aim of our study was to evaluate oxidative stress in patients with diabetes mellitus type 2 and to determine influence of acute exercise training on the investigated parameters. METHODS: To evaluate oxidative stress in the patients, we determinated following parameters: triglycerides (TG), total cholesterol, low density lipoprotein cholesterol (LDL), oxidized LDL cholesterol (Ox LDL), superoxide dismutase (SOD), glutathione peroxidase (GSHPx), plasminogen activator inhibitor (PAI) which were measured at rest and immediately after the acute bout of cardiopulmonary exercise cycle-ergometer test. RESULTS: In basal condition, diabetic patients compared to controls have significant higher values of TG (3.12 +/- 1.09 vs 1.74 +/- 0.9 mmol/L, p < 0.01), Ox LDL (84.73 +/- 16.90 vs 79.00 +/- 29.26 mmol/L, p < 0.05) and SOD enzyme activity (913.38 +/- 120.36 vs 877.14 +/- 153.18 U/g Hb, p < 0.05). During the acute exercise test, there was significant increase of Ox LDL in both the study patients (from 84.73 +/- 16.90 to 92.33 +/- 23.29 mmol/L, p < 0.05) and in the control group (from 79.00 +/- 29.26 to 89.30 +/- 29.07 mmol/L, p < 0.05). SOD activity was significantly increased in both groups during exercise, in diabetic patients from 913.38 +/- 120.36 to 921.50 +/- 130.03 U/gHb, p < 0.05, and in the controls from 877.14 +/- 153.18 to 895.00 +/- 193.49, U/gHb, p < 0.05. GSH-Px activity was significantly increased only in the diabetic patients after the acute exercise (from 45.04 +/- 11.19 to 51.81 +/- 15.07 U/gHb, p < 0.01), but not in the controls (from 44.63 +/- 13.73 to 43.97 +/- 25.97 U/gHb, p = ns). PAI significantly decreased during the exercise test, only in the healthy subjects (from 2.60 +/- 0.35 to 2.22 +/- 0.65, p < 0.05). Type 2 diabetic patients with complications had only significant increase in GSH-Px activity (from 47.10 +/- 7.37 to 54.52 +/- 11.97 U/gHb, p < 0.01). CONCLUSION: Elevated Ox LDL, SOD and GSH-Px levels are associated with acute exercise in type 2 diabetic patients. We suggest that it could be a compensatory mechanism to preventing free radicals tissue damage. We hypothesize that a physical training program induces an enhance of muscular and liver antioxidant enzymes activity and reduces oxidative stress. Further studies are needed to explore the relationship between exercise and antioxidant system in diabetic patients with and without complications.

Effects of acute exercise on atherogenic lipids in untreated mild hypertensive patients.

BACKGROUND/AIM: Exercise can positively influence risk factors associated with cardiovascular disease. The mechanisms by which exercise reduces atherogenic risk remain unknown. The aim of the present study was to investigate the effect of acute exercise (cardiopulmonary exercise cycle ergometer test) on atherogenic lipids in untreated mild hypertensive patients with or without hypercholesterolemia. This testing allows determination of exercise capacity, peak heart rate, and ventilation per minute (VE), peak oxygen uptake (pVO2) and exercise time (ET). METHODS: The study group included 85 untreated mild hypertensive patients (according to VII Joint National Committee--JNC 7) divided into two subgroups: hypertensive hypercholesterolemic and hypertensive normocholesterolemic. The control grouip included 35 normotensive subjects divided into two subgroups: normotensive hypercholesterolemic and normotensive normocholesterolemic. Lipid profiles to determine were oxidized LDL (OxLDL)--a marker of oxidative stress, triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol, which were measured at rest and 30 minutes after the acute bout of cardiopulmonary exercise cycle ergometer test. Lipids profiles were measured by enzymatic methods. Oxidized LDL was determined by a commercially available sandwich ELISA (Mercodia AB, Uppsala, Sweden). C-reactive protein (CRP) was measured using chemiluminiscent methods (Immulite-DPC). RESULTS: In our study OxLDL was significantly higher in hypertensive patients with atherogenic lipid profiles in basal condition, compared to the hypertensive patients without atherogenic lipid profiles and controls. There was a significant difference in CRP (p < 0.001) between hypercholesterolemics (hypertensive and normotensive) and normocholesterolemics (hypertensive and normotensive). We found increased OxLDL after exercise in both groups (hypertensive patients and normotensive), but only in the hypertensive hypercholesterolemic patients the difference was statistically significant (90.47 +/- 15.31 vs. 105.94 +/- 14.17 IU/L, p < 0.001). Systolic and diastolic blood pressures were significantly higher during exercise only in the hypertensive patients. There were significantly lower values of pVO2 only in hypertensive hypercholesterolemic patients. There were no significant differences between hypertensive and normotensive ones for ET and VE. In hypertensive ones we found after exercise a negative correlation between pVO2 and OxLDL (r = -0.473; p < 0.05), and pVO2 and CRP (r = -0.478; p < 0.05). We also found in normotensive normocholesterolemic patients a positive correlation between VE and systolic blood pressure (r = 0.420; p < 0.05), a negative correlation between VE and OxLDL (r= -0.421; p < 0.05), and VE and CRP (r = -0.561; p < 0.05). CONCLUSION: This study showed that acute exercise induces and increases oxidative stress only in untreated mild hypertensive patients with atherogenic lipid profiles. These results imply the need to normalize atherogenic lipid profile in untreated patients with mild hypertension in order to prevent an increased lipid peroxidation under acute exercise.

[Oxidized LDL and C-reactive protein level in relation to carotid intima-media thickness in population with risk factors for atherosclerosis].

INTRODUCTION: Elevated levels of oxidized LDL cholesterol (OxLDL) are considered to be a key factor of initiating and accelerating atherosclerosis. It promotes atherosclerosis through inflammatory and immunologic mechanisms that lead to the formation of macrophage foam cells. OBJECTIVE: To determine the relationship among OxLDL, C-reactive protein (CRP) level and carotid intima-media thickness (IMT) in population with risk factors for atherosclerosis. METHODS: The study group consisted of 125 clinically healthy, hypercholesterolaemic subjects (49.3 +/- 5.7 years; 75 females and 50 males) compared with 100 age-matched population-based control subjects. The study group was divided into two subgroups: subgroup A (the levels of LDL cholesterol > 5 mmol/L) and subgroup B (the levels of LDL cholesterol < 5 mmol/L). None of the subjects had history of cerebrovascular, ischaemic heart disease, hypertension or diabetes mellitus. Lipid profiles were measured by enzymatic methods. OxLDL was measured by using a specific monoclonal antibody, mAb4E6. CRP was measured using hemiluminescent methods (Immulite-DPC). The common carotid IMT was measured by the B-mode ultrasound. RESULTS: Compared to controls, the study group had higher levels of OxLDL (119.97 +/- 43.15 vs. 82.03 +/- 25.99 IU/L; p < 0.01) and CRP (6.20 +/- 3.55 vs. 2.68 +/- 3.04 mg/ml; p < 0.05). IMT was significantly higher in study subjects (1.14 +/- 0.38 vs. 0.72 +/- 0.24 mm; p < 0.05). We also found that, in the whole study group, IMT significantly positively correlated with OxLDL (r = 0.442; p < 0.05). We found that in the study subgroup A, IMT positively correlated with CRP (r = 0.792; p < 0.01). In controls, we found a significantly positive association between IMT and OxLDL (r = 0.781; p < 0.01) and CRP (r = 0.748; p < 0.01). CONCLUSION: The elevated levels of OxLDL and CRP are associated with higher common carotid intima-media thickness in population with risk factors for atherosclerosis.

[Antioxidant status in type II diabetes mellitus patients with or without microvascular complications].

INTRODUCTION: Lipid peroxidation and antioxidant systems are important factors affecting the metabolism of lipoproteins in diabetes mellitus. OBJECTIVE: The aim of this study was to investigate the lipid and antioxidant parameters in type II diabetes mellitus patients, and also to determine the effect of diabetic complications on these parameters. METHOD: Lipid status, Oxidized LDL cholesterol, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and plasminogen activator inhibitor (PAI-1) levels in plasma of 50 type II diabetic patients were measured with commercially available kits. RESULTS: The results showed only statistically significant higher levels of triglycerides (3.12 +/- 3.9 mmol/l) in diabetics compared with the controls. Ox-LDL cholesterol (84.7 +/- 16.9 mmol/l) and SOD activities (913.4 +/- 120.3 U/gHb) in type 2 diabetes mellitus were higher than those of the controls, but there was no statistical significance. On the other hand, in patients with diabetes mellitus and complications, LDL cholesterol, PAI-1, SOD and GSH-Px activities were higher but not significantly than those without complications. Triglycerides and Ox-LDL cholesterol were lower in the group of diabetic patients with complications in comparison to the group without complications. CONCLUSION: These results indicate that antioxidant status may be affected in type II diabetic patients and that the rise in some enzyme activities could be a compensatory mechanism to prevent tissue damage. Our results suggest that the rise in PAI-1 in type II diabetics with complications may be a good marker of vascular endothelial dysfunction.

[The influence of age and the beginning of menopause on the lipid status, LDL oxidation, and CRP in healthy women].

INTRODUCTION: Atherogenic lipid profile is an important risk factor in development of atherosclerosis in menopausal women. High level of small dense LDL, that is more susceptible to oxidation, and high levels of inflammatory markers are also associated with an increased risk for development of atherosclerosis. OBJECTIVE: The aim of this study was to investigate the relationship between lipid profile, oxidized LDL (Ox-LDL) and C-reactive protein (CRP) as inflammatory reaction in healthy women dependent on age and menopause. METHOD: The study included a group of clinically healthy women (total of 97 women). Group 1: 15 women younger than 45 years; group 2:62 women between 46 and 55 years, group 3: 20 women between 56 and 65 years, group of menopausal women (73) and group of premenopausal women (24). None of the women had history of obesity, diabetes mellitus, cerebrovascular, ischaemic heart disease, and hypertension. Lipid profiles were measured by enzymatic methods. Ox-LDL was measured by using a specific monoclonal antibody, mAb4E6. CRP was measured using hemiluminiscent methods (Immulite-DPC). RESULTS: Results showed significantly higher levels of total cholesterol (p < 0.01) and LDL cholesterol (p < 0.01) in women over 56 years compared with women younger than 45 years. We also found similar results in menopausal women. Levels of Ox-LDL (p < 0.05) and CRP (p < 0.01) showed significantly higher levels in women over 56 years. In menopausal women, we found significantly higher levels of CRP (p < 0.05). There was no significant difference in the levels of oxLDL between the menopausal and premenopausal women. Levels of triglycerides and HDL cholesterol were not different among groups. We found that 51% women had levels of HDL cholesterol lower than 1.3 mmol/L. In all groups of women, we found positive correlation among age, Ox-LDL (p < 0.01) and CRP (p < 0.01). Ox-LDL also positively correlated with CRP (p < 0.01). CONCLUSION: In healthy women older than 56 as in menopausal women, we found significantly higher levels of LDL cholesterol and inflammatory markers. These results suggest that strategies of primary prevention in women are needed to reduce the risk of developing cardiovascular disease.

Left ventricular diastolic dysfunction is related to oxidative stress and exercise capacity in hypertensive patients with preserved systolic function.

BACKGROUND: Left ventricular diastolic dysfunction and oxidative stress are important determinants in heart failure development. Peak oxygen uptake, maximal oxygen consumption, metabolic equivalents (MET), ventilatory response and time to respiratory gas exchange assess cardiopulmonary capacity. AIM: It was the aim of this study to investigate the impact of oxidative stress on diastolic indexes and cardiopulmonary exercise capacity in hypertensive patients with left ventricular diastolic dysfunction. METHODS: Mitral flow velocities (E, A), ejection fraction, left atrial and ventricular diameters were assessed by Doppler echocardiography. Superoxide dismutase (SOD) and glutathione peroxidase activity in blood were evaluated. Sixty patients (aged 49.8 +/- 9.2 years) with essential hypertension and preserved systolic function (ejection fraction 58.3 +/- 7%) performed a bicycle exercise test. Forty patients showed impaired left ventricular relaxation (E/A <1, deceleration time of E >220 ms) and were assigned to group 1, while 20 had normal relaxation (group 2). RESULTS: An increase in SOD was significantly blunted after exercise in group 1 compared with group 2 (p = 0.049). A significant difference between groups in the glutathione peroxidase level was observed before exercise (p = 0.038). There were significantly lower values of peak oxygen uptake and MET (p = 0.013 and p = 0.024, respectively) and a prolonged respiratory exchange ratio (p = 0.022) in group 1 compared with group 2. MET was significantly influenced by SOD level (p = 0.035). CONCLUSIONS: Lower antioxidative protection and impaired relaxation decrease cardiopulmonary capacity in hypertensive patients.

[Oxidized LDL and C-reactive protein as markers for detection of accelerated atherosclerosis in type 2 diabetes].

INTRODUCTION High levels of inflammatory markers are associated with an increased risk for development of coronary heart disease (CHD). The aim of this study was to estimate relations between oxidized LDL (oxLDL), C-reactive protein (CRP) and conventional lipid risk factors for CHD in type 2 diabetics without coronary heart disease. MATERIAL AND METHODS Three groups of subjects were included in the study. 44 well-controlled type 2 diabetics (25 female/19 male; 54.50 +/- 6.54 years); FBG: 5.67 +/- 0.69: HbA1c: 6.5 +/- 1.6%) without clinical signs of CHD; the second group included 24 hypercholesterolemic healthy subjects (14 female/28 male; 51.30 +/- 5.76 years). The control group included 24 normocholesterolemic healthy subjects (17 female/12 male; 48.1 +/- 8.37 years). Lipid profiles were measured by enzymatic methods. OxLDL was measured by a commercially available sandwich ELISA (Mercodia AB, Uppsala, Sweden). Hs-CRP was measured by chemiluminiscence (Immulite-DPC) using Behring Latex hs-CRP assay. RESULTS Serum oxLDL levels were significantly higher in diabetic patients (p<0.05) and subjects with hypercholesterolemia (p<0.01) compared with control subjects. Levels of CRP were significantly increased in hypercholesterolemic subjects, compared with controls (p<0.01). Levels of CRP in diabetic patients also were significantly increased compared to those of controls (p<0.05). In type 2 diabetes oxLDL significantly correlated with CRP (r=0.657; p=0.0001), TG:HDL-C ratio (r=0.690; p=0.0001). In hypercholesterolemic subjects oxLDL significantly correlated with oxLDL:LDL ratio (r=0.788, p=0.0001) but not with CRP. In controls, oxLDL significantly correlated with oxLDL:LDL ratio (r=0.679; p=0.0001, and CRP (r=0.802; p=0.0001). CONCLUSION It is of great importance to identify type 2 diabetics and hypercholesterolemic healthy subjects with high levels of oxLDL and CRP, because they are at increased risk for development of accelerated atherosclerosis.

[Case report: parathyroid gland adenoma]. / Prikaz slucaja: adenom paratiroidne zlezde.

INTRODUCTION: Primary hyperparathyroidism is a generalized disorder resulting from excessive secretion of parathyroid hormone involving one or more parathyroid glands. Both familial and sporadic forms exist. Histologic examination reveals parathyroid adenoma in about 90% of patients, although it is sometimes difficult to distinguish an adenoma from a normal gland. Primary hyperparathyroidism is commonly characterized by hypercalcemia, hypophosphatemia and excessive bone resorption. CASE REPORT: This is a case report of a 52-year old female patient with toxic thyroid adenoma and a parathyroid gland adenoma. The patient underwent partial thyroidectomy as a method of choice in treatment of toxic thyroid adenoma. Two years later, clinical hyperparathyroidism caused by an adenoma of parathyroid gland has manifested and was surgically removed. DISCUSSION AND CONCLUSION: In mild hypercalcemia, many patients are asymptomatic and this condition is frequently discovered accidentally during routine laboratory screening. In order to provide operative treatment efficiency in thyroid nodule cases, besides thyroid gland morphological diagnostics, it is necessary to perform a preoperative verification of parathyroid glands as well. This diagnostic approach is essential in identifying possible simultaneous occurrence of multiple diseases, such as: thyroid and adenoma of parathyroid gland, in order to diminish incorrect diagnostic estimates.

[Dyslipidemia and subclinical hypothyroidism]. / Dislipidemija u supklinickom hipotiroidizmu.

INTRODUCTION: Subclinical hypothyroidism is defined as an increased serum TSH and normal serum FT4 concentration. In subclinical hypothyroidism, thyroid peroxidase and thyroglobulin antibodies are frequently present. Subclinical hypothyroidism may have endogenous or exogenous causes. The prevalence of subclinical hypothyroidism is rather high. The number of patients progressing to overt hypothyroidism may be higher. These patients may be asymptomatic, or have only mild symptoms or a single symptom. MATERIAL AND METHODS: We investigated 35 patients with subclinical hypothyroidism in order to establish the type and degree of dyslipidemia and effects of therapy with L-thyroxine (50 micrograms/d) during three months. RESULTS: Serum cholesterol, LDL-cholesterol and apo B were increased. A significant reduction of serum cholesterol, LDL-cholesterol and apo B concentrations was established during thyroid hormone replacement. DISCUSSION AND CONCLUSION: Only a few studies reported higher LDL and lower HDL-cholesterol values in subclinical hypothyroidism. Much interest was thus aroused to evaluate whether or not subclinical hypothyroidism is associated with hypercholesterolemia. Only patients with serum thyrotropin (TSH) concentration above 10 mU/L had a significant reduction of serum cholesterol concentration during thyroid hormone replacement. Most patients with subclinical hypothyroidism should be treated with thyroxine to prevent progression to overt hypothyroidism. Thyroid hormone replacement therapy may slow the progression of coronary heart disease, because of its beneficial effects on lipids. These findings and especially high rate of progression towards overt hypothyroidism suggest early thyroxine treatment.

[Role of intravenous cholangio-cholecystography in the diagnosis of asymptomatic choledocholithiasis]. / Uloga intravenske holangio-holecistografije u dijagnostici asimptomatske holedoholitijaze.

INTRODUCTION: Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis), commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. DISCUSSION: In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asymptomatic ("silent") choledocholithiasis (2.02%) represents a special diagnostic and therapeutic problem. CONCLUSION: Our extended diagnostic protocol includes routine intravenous cholangio-cholecystography as a standard diagnostic procedure for evaluation of cholecysto-choledocholithiasis prior planning cholecystectomy.

[Strategies for endoscopic and surgical treatment of biliary tract calculi]. / Strategija u endoskopskom i operativnom lecenju kalkuloze zucnih puteva.

INTRODUCTION: Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitits. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. CLASSIFICATION: From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs, 2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. DISCUSSION: Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. CONCLUSION: Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis. Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.

[Lipid abnormalities in elderly patients with subclinical hyperthyroidism]. / Lipidske abnormalnosti kod starijih bolesnika sa supklinickim hipertiroidizmom.

INTRODUCTION: Sensitive thyroid-stimulating hormone (TSH) assays provide identification of many patients with subclinical hyperthyroidism resulting from excessive production or excessive replacement of thyroid hormone. Subclinical hyperthyroidism is defined by a TSH below normal (suppressed) with normal serum T3 and T4 levels. Subclinical hyperthyroidism is the goal of thyroid hormone therapy in patients with thyroid cancer, solitary thyroid nodules, multinodular or diffuse goiters, or a history of head and neck irradiation. Benefits of TSH suppression in these patients, were thought to exceed the risks of subclinical hyperthyroidism. Subclinical hyperthyroidism also occurs in patients with thyroiditis and those with autoimmune thyroid disease. Other causes of TSH suppression, such as use of glucocorticoids, severe illness and pituitary dysfunction should be excluded. MATERIAL AND METHODS: This investigation included 55 elderly patients with subclinical hyperthyroidism in order to establish the type and degree of lipid abnormalities and effects of therapy with antithyroid drugs (methimazole 10 mg/day) during three months. These patients presented with no or minimal symptoms of thyroid hormone excess, but 56% of patients experienced atrial fibrillation and cardiac hypertrophy. RESULTS: Levels of serum cholesterol, LDL-cholesterol and HDL-cholesterol were decreased. We found a significant increase of serum cholesterol, LDL-cholesterol and HDL-cholesterol levels after treatment. DISCUSSION AND CONCLUSION: Subclinical hyperthyroidism in elderly individuals is difficult to diagnose because it may present only with cardiac manifestations including atrial fibrillation and cardiac hypertrophy. There is general agreement that measurement of serum TSH is the most sensitive indicator of thyroid hormone activity in its target tissues. Patients with subclinical hyperthyroidism tend to have low serum total cholesterol, LDL-cholesterol anf HDL-cholesterol levels. These values increase after treatment. Most patients with subclinical hyperthyroidism should be treated with antithyroid drugs to prevent cardiovascular complications and bone loss, particularly among postmenopausal women.

[Total thyroidectomy in C-cell hyperplasia of the thyroid gland]. / Totalna tiroidektomija zbog hiperplazije C-celija tiroidne zlezde.

INTRODUCTION: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor of the thyroid parafollicular or C-cells. MTC accounts for approximately 3 to 5% of thyroid carcinomas. A characteristic feature of this tumor is production of calcitonin. Sporadic MTC accounts for 60-80% of all cases of the disease. The most common presentation of sporadic MTC is a solitary thyroid nodule, which occurs in 75 to 95% of patients. It typically occurs in the fifth or sixth decades, with slight female predominance. CASE REPORT: A case of a 58-year old woman with elevated basal calcitonin levels (221 pg/ml) has been presented. Preoperative ultrasound of the thyroid gland and body (99m)Tc DMSA scintigraphy showed a diffuse goiter. Hyperparathyroidism and pheochromocytoma were not present. Total thyroidectomy was performed. Only C-cell hyperplasia was found. DISCUSSION AND CONCLUSION: Many patients with elevated basal serum calcitonin level ranging between 150 and 1000 pg/ml, have only C-cell hyperplasia, but a few have small MTCs. For persons in known kindreds with familial MTC, prospective screening, using serum calcitonin measurement, can identify those at risk for the disease before MTC is clinically evident. Due to the possibility that any patient with MTC may have multiple endocrine neoplasia type 2 (MEN-2), preoperative testing must also include measurement of serum calcium (to rule out hyperparathyroidism) and a test for pheochromocytoma. Total thyroidectomy is indicated in patients with high levels of calcitonin.

[Psychological evaluation of patients with a nodular goiter before and after surgical treatment]. / Psiholoska procena bolesnika sa nodoznom strumom pre i posle hirurske intervencije.

INTRODUCTION: Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment. MATERIAL AND METHODS: In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semistructured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold") nodules presented as euthyroid, and those with autonomous ("hot") nodules (after a period of drug therapy if they were hyperthyroid), required surgery. After a period of drug therapy two groups of patients were compared: group 1--euthyroid with "cold" nodules and group 2--euthyroid with "hot" nodules. Before surgical treatment both groups underwent psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28%) while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%. DISCUSSION AND CONCLUSION: In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment.