[Advances in the etiopathogenesis, diagnosis and treatment of paragangliomas]. / Postepy w etiopatogenezie, diagnostyce i leczeniu przyzwojaków.

Paragangliomas are rare, benign or less frequently malignant tumors developing from cells of the paraganglia, a diffuse neuroendocrine system dispersed from skull base to the pelvic floor. Although paragangliomas may arise in any portion of this system, they most commonly occur below the diaphragm. Even 50% of the tumors may be hereditary and therefore genetic testing should be taken into consideration in all patients with paragangliomas. In many patients their presence leads to headaches, palpitations, sweating, or hypertension. However, subjects with nonfunctional tumors are either asymptomatic at presentation or experience only local symptoms caused by the mass effect. Functional paragangliomas can be almost always revealed by measurements of plasma concentrations of free metanephrines or 24-hour urinary outputs of fractionated metanephrines and catecholamines. There are also several morphological and functional imaging methods available that help localize neoplasm and assess its extent. In this paper, we discuss the published literature on the etiopathogenesis, diagnostic work up and the different treatment options for patients with paraganglioma. This review looks also at the recent advances in the physiology and molecular basis of these tumors.

Expression, localization and systemic concentration of vascular endothelial growth factor (VEGF) and its receptors in patients with ulcerative colitis.

Vascular endothelial grow factor (VEGF) promotes angiogenesis by activating the specific receptors KDR and Flt-1. We investigate the expression of genes encoding VEGF and its receptors KDR and Flt- 1 by RT-QPCR reaction using Quanti Tect SYBR Green RT-PCR in patients with active and inactive ulcerative colitis (UC) and control subjects. The localization and level of VEGF protein and its receptors protein in intestinal tissue were estimated by immunohistochemistry. VEGF concentration in serum and plasma was determined by ELISA. We found a significant increase of VEGF gene expression and increase expression of genes encoding receptor Flt-1 in patients with active UC when compared with controls, but KDR was present in trace amount. VEGF and Flt-1 proteins were colocalized in enterocytes as well as in endothelium and muscularis layer of the intestine. The specific staining reaction for VEGF protein as well as for Flt-1 protein was significantly higher in active UC compared with controls. Serum level of VEGF was significantly higher in active UC patients as compared with inactive UC patients as well as with controls. The plasma VEGF level was found to be significantly higher in active UC patients as compared with controls. The increase of gene expression as well as protein level for VEGF and its receptor in UC - inflamed colon, and VEGF action via Flt-1 receptor may have a functional role in UC. Increased VEGF levels in both serum and plasma in active UC patients may reflect VEGF overexpression in intestinal inflammatory tissue.

[Current views on the role of dehydroepiandrosterone in physiology, pathology and therapy]. / Wspólczesne poglady na temat roli dehydroepiandrosteronu w fizjologii, patologii i terapii.

Dehydroepiandrosterone (DHEA) and its sulfate metabolite (DHEAS) are the major androgens secreted by the human adrenal gland. The decline in their production is the most characteristic age-related change in the adrenal cortex. This process, known as 'adrenopause' may contribute to the increased incidence of atherosclerosis, cancer, or dementia in older people. The possibility of using DHEA in management has attracted considerable attention over recent years. Whereas DHEA therapy seems to be effective in treating patients with adrenal insufficiency and systemic lupus erythematosus, clinical studies investigating the potential efficacy of DHEA therapy in multiple other disorders (Alzheimer disease, depression, cardiovascular disease, osteoporosis, sexual dysfunctions) have not provided consistent results. Further research is also needed to better assess the efficacy and safety of DHEA supplementation in patients with advanced age. This review evaluates current understanding of physiology and pathology of DHEA production and summarizes the possible therapeutic value of this hormone.

[Non-steroidal anti-inflammatory drugs and intestinal side effects]. / Niesteroidowe leki przeciwzapalne a powiklania jelitowe.

Non-steroidal anti-inflammatory drugs (NSAID), including acetylsalicylic acid, are the most commonly applied in the world, however at the same time they constitute a risk factor for gastrointestinal complications. The main mechanism of action of NSAID is based on reducing the synthesis of prostaglandins by means of inhibiting the activity of cyclooxygenase (COX), namely, of COX-1, which generates gut protective prostaglandins, and COX-2, induced at the sites of inflammation, tissue lesions and certain neoplasm. Complications caused by NSAID within the upper gut are subject to numerous studies; however those affecting the intestines are considerably less known. The complications accompanying the use of NSAID may include intestinal strictures, enteropathy with anemia and the loss of protein, macroscopically inflammatory changes as erosions and ulceration, aggravated diverticulosis, and recurrences of ulcerative colitis. During treatment with NSAID the incidence of changes within the intestine is comparable to that within the upper gut. The incidence and character of complications concerning the small and large intestines are still under investigation. Frequently, post-NSAID intestinal changes may not present any clinical signs; it is only a serious complication (haemorrhage, perforation) that becomes the first symptom. Introducing selective COX-2 inhibitors into the treatment has significantly reduced the complications within both upper and lower digestive tract; however, the knowledge of the security profile for these preparations is not yet complete.