Duodenal mucosal protection by bicarbonate secretion and its mechanisms.

Proximal portion of duodenum is exposed to intermittent pulses of gastric H(+) discharged by the stomach. This review summarizes the mechanisms of duodenal mucosal integrity, mainly the role of mucus-alkaline secretion and the mucous barrier protecting surface epithelium against gastric H(+). The mucous barrier protects the leaky duodenal epithelium against each pulse of gastric H(+), which penetrates this barrier and diffuses into duodenocytes, but fails to damage them due to; a) an enhanced expression of cyclooxygenase-1 (COX-1), with release of protective prostaglandins (PG) and of nitric oxide (NO) synthase (NOS) with, however, production of NO, stimulating duodenal HCO(3)(-) secretion and b) the release of several neurotransmitters also stimulating HCO(3)(-) secretion such as vasoactive intestinal peptide (VIP), pituitary adenylate-cyclase activating polypeptide (PACAP), acetylcholine, melatonin, leptin and ghrelin released by enteric nerves and mucosal cells. At the apical duodenocyte membrane at least two HCO(3)(-)/Cl(-) anion exchangers operate in response to luminal H(+) to provide adequate extrusion of HCO(3)(-) into duodenal lumen. In the basolateral portion of duodenocyte membrane, both non-electrogenic (NBC) and electrogenic (NBC(n)) Na(+) HCO(3)(-) cotransporters are activated by the exposure to duodenal acidification, causing inward movement of HCO(3)(-) from extracellular fluid to duodenocytes. There are also at least three Na(+)/H(+) (NHE1-3) amiloride-sensitive exchangers, eliminating H(+)which diffused into these cells. The Helicobacter pylori (Hp) infection and gastric metaplasia in the duodenum with bacterium inoculating metaplastic mucosa and inhibiting HCO(3)(-) secretion by its endogenous inhibitor, asymmetric dimethyl arginine (ADMA), may result in duodenal ulcerogenesis.

[The comparison of selected parameters of structure and function of the cardiovascular system in patients with functioning graft on maintenance hemodialysis during a one year period]. / Porównanie wybranych wskazników opisujacych strukture i funkcje ukladu krazenia u pacjentów po przeszczepieniu nerki oraz chorych hemodializowanych w okresie jednego roku.

Successful renal transplantation allows to correct most of the abnormalities that lead to cardiovascular system injury in chronic uremia. The aim of the present study was to analyze selected anatomical and functional parameters of the heart using echocardiography. The study was conducted prospectively in two groups of patients: 73 subjects with functioning graft and 53 patients on maintenance hemodialysis. Obtained results were compared between those two groups at the start of the study and later on after 6 and 12 months of follow-up. Post-transplant patients were included into the study 11 +/- 6.4 months after successful transplantation. Mean dialysis period prior to transplantation was 35 +/- 21 months. Patients in the control group were dialyzed for mean 54 +/- 25 months. The prevalence of various diseases of the cardiovascular system was equal in both groups of patients (most frequently diagnosed was hypertension). There was no difference in ejection fraction within groups during the whole study period, however the value of this parameter was higher among patients with functioning graft at the beginning of the study (p < 0.01) as well as after 6 and 12 months (p < 0.001) as compared to patients on dialysis. The prevalence of different morphological abnormalities of the heart, such as concentric hypertrophy, left ventricle dilatation, valve dysfunction as well as calcification of various structures, was equal in both groups of patients at the beginning of the study. In 87.7% of patients with functioning graft, left ventricle hypertrophy was diagnosed at the beginning of the study (mean LVMI value 176.9 +/- 55.5 g/m2) and this percentage decreased to 63% after 6 months (LVMI 155.8 +/- 60.3 g/m2; p < 0.001 vs. baseline) and 53.4% after 12 months (LVMI 141.6 +/- 62.1 g/m2; p < 0.001 vs. baseline). Regression of initial left ventricle hypertrophy, although less pronounced was also present among patients on maintenance dialysis. There was no difference in LVMI value between the studied groups at the beginning of the study, whereas after 6 and 12 months of observation it became significantly lower in patients with functioning graft (155.8 +/- 60.3 vs. 179.5 +/- 50.9 g/m2; p < 0.01 and 141.6 +/- 62.1 vs. 176.2 +/- 50.5 g/m2; p < 0.001). Based on obtained results we conclude that successful renal transplantation promotes the normalization of a number of echocardiographic parameters, especially leads to regression of left ventricle hypertrophy. Renal transplantation seems to be an optimal method of treatment in patients with end-stage renal failure, considering structure and function of the cardiovascular system.

[Microbiological threat from buildings and rooms and its influence on human health (sick building syndrome)]. / Mikrobiologiczne zagrozenia budynków i pomieszczen mieszakalnych oraz ich wplyw na zdrowie (syndrom chorego budynku).

In buildings we can observe many different strains of bacteria, over 400 species of mould fungi, many strains of fungus causing the rotting of wood and wood like materials, many species of algae, aphids, and other types of growths and seed plants and also over 30 types of mites especially those seen in house dust. Buildings, especially their interiors have a very specific microclimate. Within it areas of so called ecological lows are formed in which conditions for settlement, growth and reproduction of these organisms take place. A building, which is a hazard to the health of its residents, is called a "sick building" from the term "sick building syndrome". The incidence and development of some types of mould fungus is associated with the production of very toxic metabolites which are called secondary metabolites i.e. mycotoxins. Long term human, especially in relation to children, contact with the species producing the most potent mycotoxins like aflatoxin--Apergillus flavus, ochratoxins--Aspergillus ochraceus, rubratoxins--Penicillium rubrum or strachybotrytoxins--Strachybotrys chartarum may even be the cause of death. Mould fungus or just mould is a saprophytic fungus derived from many different systemic groups (Mucor, Aspergillus, Penicillium, Fusarinum). Fungi can produce lethal mycotoxins such as: alternariol, aflatoxins, gliotoxins, ochratoxins, nivalenol, cytinine, dicumarol, rugulosine, trichoviridine and about 200 more which considering their mutagenicity are potentially dangerous to humans, animals, flora and microorganisms. Research which was begun by Prof. Julian Aleksandrowicz and Prof. Boleslaw Smyk in 1970 and 1971 showed that the so called "leukaemia houses" of leukaemia victims had an abundance of toxinogenic fungus in them, particularly the most potent fungus which turned out to be Aspergillus flavus. Toxinogenic funguses are abundant in many living spaces and cellars in older and also in new housing. Mycotoxins have been shown to be very toxic and harmful and it is no wonder that many inhabitants of these living spaces are constantly ill, mainly upper respiratory tract infections, lethargy, constant headaches, nausea and a general ill feeling. Inhabiting these living spaces for a considerable period may lead to cancer.

[Health-toxicologic aspects of some fungi]. / Aspekty zdrowotno-toksykologiczne grzybów plesniowych.

Recent findings of fungi in food products of such renomed companies as Coca-Cola and Danone resulted in society-wide alert in Poland. Humans have contact with fungi everywhere. Every food product covered with mould or having marks of it should be discarded. We should mention that cutting of or skimming the mould is totally ineffective and dangerous, because of the fact that rest of the product will contain products of fungal metabolism such as mikotoxins, which are, of course, invisible. Modern food producing technologies effected in microorganism-free products, but sporadically we can find dead fungi debris due to improper washing procedures of multi-use bottles, like it was observed in Coca-Cola products. As for mould-covered cottage cheese type products of Danone, most probably reason was improper handling of ready, sealed products during transport and storage. Even minimal physical injuries to air-tight containers resulted in sporae penetration to milk products and finally contamination with mikotoxins.

[Aluminum--occurrence and toxicity for organisms]. / Glin--wystepowanie i toksycznosc dla organizmów.

Aluminium (Al.) is an ubiquitous element found in every food product. The sources of Al. are especially corn, yellow cheese, salt, herbs, spices, tea and tap water. In household Al.-made ware is a major source of the element. Al. may cause diseases in humans, especially hampers many metabolic processes especially turnover of calcium, phosphorus and iron. Salts of Al. may bind to DNA, RNA, inhibit such enzymes as hexokinase, acid and alkaline phosphatases, phosphodiesterase and phosphooxydase. Al. salts are especially harmful to nervous, hematopoietic systems and to skeleton. Al. gets to organism with food, water, cosmetics, from aluminium ware and containers. Toxicity comes from substitution of Mg and Fe ions effecting in disturbances in intracellular signaling, excretory functions and cellular growth. Neurotoxic action of Al. probably comes from substitution of Mg ions in ATP, what finally influences function of every ATP using-enzymes. There are observations in experimental models proving Al. salts are responsible for Alzheimer disease development. Toxicity of Al. to skeletal system results in diminished resistance thus tendencies to breaking, and comes from lower collagen synthesis and slowing down of mineralisation. Low erythropoietin production, inhibition of hem-synthesing enzymes and binding of Al. to transferrin, effects in anaemia. Carcinogenic effects of Al. were nor proved nor denied, but high concentrations of Al. were found in many neoplastic cells. In conclusion, we should introduce prophylactic measures effecting in less Al. intake esp. avoiding use of Al.-made ware nad controlling food for Al. content.

[Probiotics and their therapeutic properties]. / Probiotyki oraz ich terapeutyczne wlasciwosci.

Probiotics are specific products of microorganisms, and by being biologically active positively act on stabilizing the bacteriological flora of the gastrointestinal tract. They are live or lyophilized bacterial cultures, especially those derived from lactic fermentation (Lactobacillacea and Streptococcacea). The first to use the term probiotics were Lilly and Stillwell in 1965 when referring to substances produced by protozoa, which in turn stimulated the growth of other organisms. Probiotics are devoid of side affects and do not cause accumulation of toxic substances in the body. They are administered for therapeutic, prophylactic and nutritional purposes both in humans and in animals. Interest into probiotics has been spurred on by the growing abundance of civilization disorders such as neoplasms, atherosclerosis, heart disease, hypertension and HIV infection. Probiotics are potentially capable of annihilating these disorders. Starter cultures are pure mixed bacterial, fungal or mold cultures which by transformation of their metabolism faciliate favourable changes in apperance, aroma, consistency, and durability of foodstuffs. Contemporary knowledge concerning probiotics and their action is derived from many years of tradition in consumption of fermented milk products and the documentation of much research into strains of lactic bacteria, their harmless action on health and overall beneficial effect.

[Peri-renal pheochromocytoma]. / Guz chromochlonny o pozanerkowej lokalizacji.

Presented is a case of pheochromocytoma with an ectopic or extrarenal localisation in a 47 year old female farmer. The patient was admitted to the 1st Chair and Clinic of Internal Disease, Jagiellonian University Collegium Medicum due to a three year history of hypertension. The bouts of hypertension were characterised by sudden increases of blood pressure to 250/150 mmHg, which occurred after physical exertion but particularly during the night. On physical examination no abnormalities were detected. Laboratory analysis revealed no changes apart from mild hyperglycemia. 24 hour vanillymandelic acid excretion was normal on two successive accounts, but on a third analysis was raised. Fundus examination revealed bilateral hypertensive and diabetic angiopathy. Abdominal ultrasound revealed a tumor in the region of the pancreas with an echogenicity similar to that of the liver. Abdominal CT scan revealed normal suprarenal glands bilaterally. A smooth walled tumor of 55 mm diameter was visualized below the head of the pancreas. Its structure was not uniform with degenerating features. The tumor adhered to the descending and transverse part of duodenum, compressing the vena cava inferior and was in close proximity to the abdominal aorta. After surgical consultation the patient was transferred to the II Clinic of General Surgery Jagiellonian University Collegium Medicum where after pretreatment with alpha and beta blockers, ACE inhibitors, diuretics and Insulin CHOS the patient underwent surgery. Posterior to the duodenum, inferior to the head of the pancreas, between the aorta and vena cava inferior was a polycystic tumor of 80 mm diameter, which was evacuated in its entirety. Histopathology revealed a paraganglioma with an appearance of pheochromocytoma. On a three month follow up visit the patient was without symptoms. Her blood pressure and glycemia were normal despite being without treatment.

Treatment of peripheral vascular disease with misoprostol (Cytotec): a pilot study.

Misoprostol, the oral analogue of alprostadil, was used to treat 20 patients (aged 40-60 years) with peripheral arterial disease (PAD) according to Fontaine's classification at stages IIa and IIb. All patients received 200 micrograms of misoprostol 3 times a day during a month. The therapy with misoprostol resulted in clinical improvement in all patients. Elongation of pain-free (before treatment: 129 m +/- 78 m; after treatment: 214 m +/- 109 m) and maximum walking distance (before treatment: 304 m +/- 169 m; after treatment: 471 m +/- 264 m) was observed. At the same time, a shortening of the duration of pain was noted (before treatment: 100 sec +/- 37 sec; after treatment: 71 sec +/- 23 sec). The ankle/arm pressure ratio (AAPR) and arterial blood flow increased in both limbs after 4 weeks of treatment. Activation of the fibrinolytic system was seen in the course of therapy (shortening of euglobulin clot lysis time (ECLT) and increase in t-PA activity). The platelets became less sensitive to ADP and collagen after intake of misoprostol. The results justify administration of misoprostol as a new therapeutic agent for the treatment of patients with PAD.

[Molsidomine: importance in treatment of circulation disorders]. / Molsidomina: znaczenie w leczeniu chorób ukladu krazenia.

Molsidomine, coronary drug which acts similar to organic nitrates, belongs to the drug class of sydnones . SIN-1A metabolite of Molsidomine has pharmacologically active group of NO, which by increasing levels of cGMP, decreases levels of intracellular calcium ions in smooth muscle cells. This effect leads to relaxation of smooth muscle vasculature, inhibits platelets aggregation and has indirect antiproliferative effect. In clinical observations no effect of tolerance to the drug was observed. Experimental data show additional mechanism of action of the drug: SIN-1C metabolites protects the reoxygenated cardiomyocyte from post-reperfusion damage. Indications for use of Molsidomine are: ischaemic heart disease, chronic heart failure and pulmonary hypertension. Effects of Molsidomine use in acute myocardial infarction and unstable angina were compared in clinical trials to effects of nitroglycerin use. Both drugs were found equally potent, but authors underline the fact of better Molsidomine tolerability comparing NTG, but longer serum half-time of Molsidomin effects that control of the treatment is worse. In clinical trials it was suggested that intravenous use of Molsidomine metabolite SIN-1 during PTCA procedures is more effective than use of isosorbide dinitrate in the same procedures. In other clinical trials molsidomin was found to produce beneficial effects in patients with heart failure due to ischaemic cardiomyopathy, dilatative cardiomyopathy, in essential hypertension, pulmonary artery hypertension in COPD patients and in congestive heart failure.

[Foreign body imitating bronchial neoplasm]. / Cialo obce imitujace raka oskrzela.

A case of 53 year-old male admitted to the Clinic with fever and persisting cough with a muco-purulent secretion, varying in intensity for about 4 months, was presented. Prior to the admission to the Clinic the patient was treated with antibiotics, which only slightly relieved the symptoms mentioned above. The patient was admitted to the Clinic with diagnosis of chronic bronchitis, right sided bronchopneumonia with a suspicion of lung cancer. Performed chest X-ray seemed to confirm this diagnosis. Later on, tomography scans and bronchoscopy demonstrated a foreign body in the bronchus. Bronchoscopy not only allowed to exclude neoplastic change but also enabled us to "treat" the patient by extracting his molar tooth remained in the main right bronchus, which caused purulent inflammatory changes in this bronchus. After subsequent antibiotic therapy patient's general condition improved and radiological chest image returned to normal. Persistent cough and recurrent fever are often the symptoms of the lung cancer. It should be emphasised that in the observed case longterm treatment of these changes lasted for 4 months without chest radiological examination.

[Current capabilities and procedures for diagnosing lung neoplasms]. / Wspólczesne mozliwosci i zasady rozpoznawania raka pluca.

Lung cancer is the most common malignant cancer in males and it's incidence is rapidly rising in females. Factors linked to this are associated with cigarette smoking, urbanization along with atmospheric pollution. The lack of success in the treatment of lung cancer has to do with in many cases late diagnosis at the stage when surgical treatment is not possible and radio and chemotherapy being of minimal effectiveness. The WHO has proposed the following classification of lung cancer: 1. Squamous cell carcinoma; 2. Small cell carcinoma; 3. Adenocarcinoma; 4. Giant cell carcinoma; 5. Adeno-squamous cell carcinoma 6. Carcinoid. 7. Carcinoma of mucous gland. 8. Others. Early physical signs of lung cancer are: cough (50-80% of patients), dyspnea (10-15%), chest pain (15-20%), hemoptysis (20-50%), recurrent pneumonia and bronchitis (30-50%). More serious clinical signs associated with growth of the neoplasm are hoarseness, pleural effusion, vena cava superior syndrome, and Pancoast's syndrome. The growing neoplasm secrets many biochemical substances, which are them activity passed on the bloodstream or make their way into the blood as a result of degeneration of the tumor. These substances may then be detected in the patient's plasma and act as markers of malignant disease. The characteristics of these markers is varied, e.g.: hormones, enzymes and tissue antigens. Methods used in the diagnosis of lung-cancer which should be stressed, are apart from the obvious physical examination are chest x-rays, ultrasound, CAT scans, nuclear magnetic resonance, PET scans, and scintigraphy. Fine needle aspiration in changes in the peripheral regions, cytology of sputum, bronchial lavage, cytogenetic analysis. This underlines the need for prophylaxis, particularly the cessation of cigarette smoking.

[Etiology and pathogenesis of urolithiasis]. / Etiologia i patogeneza kamicy ukladu moczowego.

For ages nephrolithiasis has been a widespread disease and clinical statistics prove that its morbidity index is still increasing, thus it becomes a social problem. Peak morbidity usually occurs at the age between 30 and 40, that is why many patients professionally active and creative have to leave their jobs for a long period. In contrast to earlier years, frequency of the disease occurrence in females is systematically increasing and nowadays it is only slightly lower from that in males. Etiology and pathogenesis of the disease is also not entirely explained. It is generally accepted that urinary stone formation is determined by multiple factors which affect first of all chemical composition and physical features of urine. Individual properties of the kidneys and urinary tract and infections especially with urease producing pathogens as well as environmental factors are also taken into account. The most favourable circumstances for nephrolithiasis occurrence is co-existence of all these factors.

[Diagnosis, prophylaxis and treatment of urolithiasis]. / Diagnostyka, profilaktyka i leczenie kamicy ukladu moczowego.

Urolithiasis is a disease with complex and not fully explained etiology and pathogenesis. In its development there play role multiple factors, such as individual features of the kidneys and urinary tract, co-existing infections with urease-producing pathogens and environmental factors. Advance in the field of organ imaging has enabled development of new harmless diagnostic procedures that allowed for fast diagnosis, and current methods of treatment (USR, PCNL and ESWL) have significantly limited the number of surgical procedures performed because of urolithiasis. Introduction of these treatment methods markedly disturbed used for a long time scheme of management and in many cases it limited invasiveness of the treatment and shortened hospitalisation time. Unfortunately, not all urology departments in Poland have access to the newest methods of treatment, thus a percentage of patients treated with traditional methods is still high. Used nowadays methods of diagnosis and treatment have not fully solved a problem of urolithiasis metaphylaxis, and urolithiasis still remains a serious disease that requests close cooperation of the patients, nephrologist and urologist.

[Selected renal complications during the course of multiple myeloma]. / Wybrane powiklania nerkowe w przebiegu szpiczaka mnogiego.

Multiple myeloma is the most frequent dysproteinemia leading to nephropathy. The aim of the study was to analyse this complication in patients treated in nephrological departments. The study was performed in 83 patients (45 M, 38 F) aged 47-82 years in whom a diagnosis of multiple myeloma was based on clinical manifestation (weakness, subfebrile states, bone aches, loss of body weight, recurrent infections of urinary and respiratory tracts), increased number of plasmocytes in bone-marrow, presence of monoclonal protein in serum and/or urine and lesions in bone system. In a significant number of the studied patients the disease was revealed while diagnosing proteinuria as well as searching for a reason of elevated erythrocyte sedimentation rate or proteinogram abnormalities. The obtained results indicate that signs of nephropathy in the course of multiple myeloma may be the first visible symptoms of the disease. Proteinuria was observed in 79.5% of the studied patients. Bence-Jones protein was found in 41% of individuals and features of renal failure in different stages of development in 67%. Dialysis therapy was started in 3 patients with acute and 7 patients with chronic renal failure.

[Misoprostol--oral prostanoid--the first clinical trial for use in patients with peripheral vascular disease]. / Mizoprostol--doustny prostanoid--pierwsza próba klinicznego zastosowania w chorobie niedokrwiennej konczyn dolnych.

Misoprostol, the oral analogue of alprostadil was used for the treatment of 20 patients (aged 40-60) with peripheral arterial disease according to Fontaine's classification at stages IIa and IIb (PAD). All patients received 200 micrograms of misoprostol 3 times a day during a month. The therapy with misoprostol resulted in a clinical improvement in all patients. Elongation of pain free (before treatment 129 m +/- 78 m, after treatment 214 m +/- 109 m) and maximum walking distance (before treatment 304 m +/- 169 m, after treatment 471 m +/- 264 m) was observed. At the same time a shortening of the pain duration was noted (before treatment 100 sec +/- 37 sec, after treatment 71 sec +/- 23 sec). The ankle/arm pressure ratio (AAPR) and arterial blood flow increased in both limbs after 4 weeks of the treatment. Activation of the fibrinolytic system was seen in the course of the therapy (shortening of euglobulin clot lysis time-ECLT and increase in t-PA activity). The platelets became less sensitive to ADP and collagen after intake of misoprostol. The results justify administration of misoprostol as a new therapeutic agent for the treatment of patients with PAD.

[Kallikrein in the treatment of patients with obliterative atherosclerosis of the lower limbs and its mechanism of action]. / Kalikreina w leczeniu chorych na zarostowa miazdzyce tetnic konczyn dolnych oraz próba wyjasnienia mechanizmu jej dzialania.

Kallikrein (Padutin-Depot) was administered to 20 patients with obliterative atherosclerosis of the lower limbs of the II degree (19 patients) and IV degree (1 patient). The drug was given in the daily dose of 40 U i.m. for 28 days. An effect of kallikrein on the distance in intermittent claudication, rate of pain relieve after walking the maximal distance, blood flow in the lower limbs, and on the index of circulating aggregates have been determined. Clinical improvement has been noted after a 4-week therapy with kallikrein. The drug in a single dose of 40 U activates plasma fibrinolytic system for 5 hours and decreases the number of circulating aggregates (2-5 h). The authors explain kallikrein action as the release of endogenous bradykinin, which subsequently releases two epithelial mediators, i.e. PFG1 and EDRF.

[Health status of the workers exposed to strong, constant magnetic fields]. / Ocena stanu zdrowia pracowników narazonych na dzialanie silnych, stalych pól magnetycznych.

Forty two workers underwent examinations under clinical conditions. The workers were affected by the magnetic field of intensities ranging between 112-190 Gauss, depending on the workplace. They underwent internal, ophthalmological, psychological, psychiatric and analytical examinations and the health status of those exposed was compared to that of twenty controls. Most subjects, mainly those of long length of employment in e-m fields exposure, exhibited nonspecific abdominal pains, general weakness, insomnia, increased thirst and conjunctivitis.

Prostacyclin and blood glucose levels in humans and rabbits.

In patients with peripheral vascular disease and in healthy rabbits, infusion of PGI2 but not of 6-keto PGF1 alpha induced a rise in blood glucose level and a pathological deviation in glucose tolerance test. In experiments in vitro, the increased concentrations of glucose produced dose-dependent inhibition of PGI2 release from isolated rat aortic rings. The link between PGI2 and carbohydrate metabolism is discussed.