[Effect of smoking on lipoprotein metabolism]. / Uticaj pusenja na metabolizam lipoproteina.

INTRODUCTION: Recent aspects concerning effects of smoking on lipoprotein metabolism are presented as well as their harmful effects on blood vessels. It has been proved that smoking stimulates oxidation of LDL particles, producing a significant increase of triglycerides and a decrease of HDL-cholesterol, mostly due to HDL, subfraction diminution. LIPID AND LIPOPROTEIN DISORDERS: Changes of other lipid and lipoprotein parameters are not significant and may even not be found in certain investigations. They are independent of age, body mass, physical activity, alcohol consumption and hormonal status in women; however, they are affected by inappropriate diet. A complete and very fast reversibility of changes after smoking cessation is significant and is important while taking blood for laboratory analyses and interpretation of results. Concerning atherosclerosis, increased oxidation in LDL particles is of great significance. It is established that in vitro exposition of LDL particles to the cigarette smoke induces their increased oxidation and in smokers an increased antibody level of oxidased LDL particles is found. CONCLUSION: A number of arguments speak in favor to the opinion that the unique mechanism by which smoking affects lipoprotein metabolism is its connection to the insulin resistance phenomenon.

[Obesity and respiratory tract disorders]. / Gojaznost i poremecaji respiratornog trakta.

INTRODUCTION: Although in the shade of metabolic and cardiovascular complications, respiratory tract disorders are very frequent and are predominant in extremely obese subjects with body mass index (BMI > 4O kg/m2), most often of gynoid type. CLASSIFICATION OF DISORDERS: These disorders can be classified into four groups: 1. Respiratory function disorders without alveolar hypovenitilation, 2. Pickwickian syndrome, 3. Sleep apnea syndrome and 4. Risks during surgical interventions. CONCLUSION: This study includes detailed discussion of mechanisms of origin, pathophysiologic characteristics and clinical signs of each of these disorders and at the end a review of their treatment.

[Specificity of lipid and lipoprotein status in healthy students at the University of Novi Sad]. / Specificnosti lipidskog i lipoproteinskog statusa zdravih studenata Novosadskog Univerziteta.

INTRODUCTION: The aim of this study was to determine the frequency of hyperlipoproteinemias and normolipidemic dyslipoproteinemias, and distribution of desirable, borderline and high-risk values of certain lipid status parameters in healthy young individuals. MATERIAL AND METHODS: In this investigation we examined 213 students of the University of Novi Sad of both genders, 20-30 years of age. Standard biochemical methods were used to determine values of total serum cholesterol, triglycerides, HDL cholesterol, and lipoproteins by cellulose acetate electrophoresis. The level of LDL cholesterol and LDL/HDL cholesterol and total/HDL cholesterol ratios were calculated. RESULTS: In this group hyperlipoproteinemia was established in 42.3% of cases and normolipidemic dyslipoproteinemia in 65.3%. Total serum cholesterol was minimally elevated in 39.0% of tested students, elevated with high risk in 3.3% and triglycerides were minimally elevated in 1.0%. Presence of elevated LDL cholesterol (24.4% minimally and 13.2% with high risk) is remarkably significant. HDL cholesterol is minimally decreased in 54.0% of tested students, and severely in 3.3%. DISCUSSION: The tested parameters deviate from desirable levels with an alarmingly high frequency, given the fact that this is a group of healthy young individuals with no previous history of lipid and lipoprotein metabolism disorders. It can be hypothesized that a joint hyper Lp(a)-lipoproteinemia can exist with a significant occurrence. These results could be associated with similar disorders in families of tested students, unhealthy food habits and lifestyle, use of oral contraceptives and smoking. CONCLUSION: Our results point to the need for performing gradual laboratory diagnostic procedures for routine check-ups in students.

[Hyperinsulinemia as a key factor in the development of many metabolic disorders]. / Hiperinsulinemija kao kljucni faktor u nastanku brojnih metabolickih poremecaja.

Insulin resistance and consequent hyperinsulinemia present a frequent disorder and according to some investigations it is present in a quarter of whole population. Leaving aside numerous genetic syndromes caused by pronounced insulin resistance, this paper surveys the influence of specific arrangement of fat tissue in the development of this disorder, its role in insulin-independent form of diabetes, development of lipidic and lipoproteinic disorders, in the essential arterial hypertension, and finally, in the appearance of accelerated and premature atherosclerosis. Further intensive investigations of this problem will probably result in achieving a definite explanation of the importance of hyperinsulinemia as a marker of cardiovascular risk.

[The metabolic syndrome and hyper-Lp(a)-lipoproteinemia in peripheral obliterative atherosclerosis: 2 case reports]. / Metabolicki sindrom i hiper-Lp(a)-lipoproteinemija u perifernoj obliterantnoj aterosklerozi: povodom dva slucaja.

One of the characteristics of peripheral vascular disease in diabetic patients is that it occurs at the time of detection of diabetes mellitus. As one of the possible pathogenic mechanisms, in non-smokers, is the sol-called metabolic syndrome (obesity, disorders in regard to metabolism of lipids and carbohydrates and hypertension). Lipoprotein Lp(a) is the most atherogenic among lipoproteins. While data on coronary arterial disease exist, although contradictory, there is a small number of those which document the same for peripheral vascular occlusive disease in diabetics. Two patients, non-smokers, with characteristic constellation of risk factors, are described as possible models for further epidemiologic examinations.

[Serum lipids in surgical and natural postmenopause]. / Serumski lipidi u hirurskoj i prirodnoj postmenopauzi.

Values of serum lipids in women of different estrogenic status were analyzed in this paper. A deficit of estrogen was established in groups of surgically induced and natural postmenopausal women, but a relatively preserved production of estrogenic hormones in the group of women with preserved ovaries and group of premenopausal women. Serum triglycerides, the total serum cholesterol and LDL fraction of cholesterol were highest in surgically induced premenopausal women, somewhat lower in natural postmenopausal women, while they were statistically significantly lower in premenopausal women and women with preserved ovaries. Values of HDL cholesterol did not statistically significantly differ in certain groups of women. Index of atherosclerosis (IA) was highest in surgically induced postmenopausal women (3.18), somewhat lower in natural postmenopausal women (2.99) and premenopausal women (2.64), while it was statistically significantly lower in women with preserved ovaries (2.57).

[Determination of lipoprotein Lp(a) in clinical practice: personal experience]. / Znacaj odredivanja lipoproteina Lp(a) u klinickoj praksi: nasa iskustva.

The paper presents up-to-date knowledge on structure, origin, metabolic ways and physiologic role of lipoprotein Lp(a). Apart from discussing analytic actions, plasmatic distribution and conjunction with atherosclerosis, results of our own investigations which took several years performed in about 5000 patients are being reported as well as directives for rational diagnostic and therapeutic approaches.

[Prolactin secretion in hyperthyroid individuals]. / Stanje prolaktinske sekrecije kod hypertireoidnih osoba.

Several endocrine and metabolic changes occur in hyperthyroidism, among which also changes in prolactin secretion are present. Causes are numerous. However, a decreased content of prolactin in secretory granules of the lactotrophic cells in the adeno-hypophysis gland, e.i. a decreased prolactin pool, should be especially emphasized. Prolactin secretion of the adeno-hypophysis gland was examined in 30 hyperthyroid patients. Normoprolacinaemia was diagnosed in basal conditions, but prolactin response was not so great during stimulation tests (test with thyrotropic hormone and eglonylic test) and suppression tests (L-DOPA and bromo-cryptic test). This finding suggests the existence of a decreased prolactin pool in hyperthyroidism.

[The role of ultrasonography in the diagnosis of enlarged parathyroid glands]. / Mesto ultrasonografije u dijagnostici povecanih paratireoidnih zlezda.

The ultrasonographic diagnosis of parathyroid glands was introduced by the Japanese in 1975. Only after more perfect machines have been introduced, first of all by advancement of "real-time" technique, this method started being used as a routine. The paper shows results of ultrasonographic investigation in 200 patients separated into two groups. In the first group 100 patients were examined with a clinical suspect of primary hyperparathyroidism from which in 30 the existence of parathyroid gland adenoma was diagnosed. Scintigraphy of parathyroid glands was performed in the smaller group of patients; the comparison of these two methods was done, and in 77.7% cases coincidence was found. In the group of 10 operated patients comparison of the two mentioned methods was carried out, with surgical or pathohistologic findings and the coincidence was complete. In the second group 100 patients were examined belonging to the chronical program of hemodialysis, from which in 24 cases existence of swollen parathyroid glands was found. Comparison of ultrasonographic and scintigraphic findings was also done and the coincidence was 68.75%. At the end, the importance of ultrasonography in the first diagnostic stage of swollen parathyroid glands was pointed out.

Red blood cell deformability in diabetes mellitus: effect of phytomenadione.

Decreased deformability of red blood cells (RBC) in diabetes mellitus (DM) is considered to be linked to microcirculatory complications in this condition. As we found that phytomenadione increased RBC deformability in experimental animals, the question was raised, whether phytomenadione had the same effect on the RBC of diabetic patients. The study was performed in 10 patients with insulin-dependent diabetes mellitus, where the erythrocyte deformability was impaired. Patients received 10 mg/day phytomenadione i.m. for five days. Deformability was measured with policarbonate membranes (Nucleopore) with pore diameter 5 microns, under gravity. The results were expressed as the ratio (r) between the flow of 1.5 ml (r1) and 2 ml (r2) of RBC suspension and 1.5 ml of buffer. Phytomenadione increased the erythrocyte deformability in patients with diabetes mellitus, lowering the value r1 from 3.54 +/- 0.84 to 2.32 +/- 0.61 (p 0.02) and r2 from 7.80 +/- 2.41 to 4.65 +/- 1.07 (p 0.01). The values after treatment reached the range of healthy controls (r1 3.11 +/- 0.98, r2 6.52 +/- 3.04). The whole blood viscosity was significantly lowered after phytomenadione (5.28 +/- 0.58 mPas before, 4.64 +/- 0.74 mPas after, p < 0.02) with unchanged plasma viscosity, but significantly lowered internal viscosity of erythrocytes.

[Hypophyseal pseudomacroadenoma in primary hypothyroidism--2 case reports]. / Pseudomakroadenomi hipofize u primarnom hipotireoidizmu--povodom dva slucaja.

Primary hypothyroidism is often accompanied with hyperprolactinemia and if the untreated disease persists longer hypophyseal adenoma consisting of thyreotropic cells might develop. On the other hand, although rarely, simultaneous occurrence of primary hypothyroidism and hypophyseal prolactin adenoma might be encountered. If substitutional therapy, after the establishment of euthyroid status, does not eliminate clinical signs of hyperprolactinemia and normalize prolactin levels, a decision can be made in favor of hyperprolactinemia within primary hypothyroidism. In that case possible tumor changes in the hypophysis will show regressive tendency towards final disappearance. However if clinical signs and hyperprolactinemia persist after the establishment of euthyroid status, especially if accompanied with compressive signs this should be regarded as a coincidence of primary hypothyroidism and hypophyseal prolactin tumor. We report two female patients with primary hypothyroidism and hypophyseal pseudomacroadenoma.

[Psychological characteristics of obese persons with special reference to periods of modified fasting]. / Neke psiholoske karakteristike gojaznih osoba s posebnim osvrtom na period sprovodenja modifikovanog gladovanja.

It is well known fact that the results of modified fasting can be improved if the basic therapeutic method is combined with psychotherapeutic procedures. We have analyzed the data taken by a poll from 55 extremely obese women treated by modified fasting regimen. The results absolutely justify the above mentioned remark that radical reduction cures may cause critical moments most frequently recognized in hunger crisis when patients feel a need for conversion with medical staff. With no doubt, any help from a qualified person might be perfectly beneficial. Besides, obese persons are more inclined to depressive moods which may aggravate during these cures. In order to maintain the achieved result for a longer period of time if not for good, a continuous team work which include psychotherapeutic measures is of special significance. On the highest level it would be smart to establish an association of treated obese people, which would be a link between a patient and a professional.

[The metabolic X syndrome--4 case reports]. / Metabolicki sindrom X--povodom cetiri slucaja.

The study reviews current knowledge about metabolic X syndrome characterized by android obesity, arterial hypertension, insulin resistance with hyperinsulinemia and disturbed carbohydrate tolerance, a decrease of HDL cholesterol and an increase of the triglyceride rich VLDL particle level. The study describes 4 female patients having been diagnosed for this syndrome. Only an ontime and vigorous reduction of overweight, along with intensified physical activity can prevent later development of serious complications, first of all, in cardiovascular system.

[Multicenter study of the efficacy and tolerance of gemfibrozil and fenofibrate in the treatment of primary hyperlipoproteinemia]. / Multicentricna studija efikasnosti i podnosljivosti gemfibrozila i fenofibrata u lecenju primarne hiperlipoproteinemije.

In the primary prevention of atherosclerosis and risk of lipoproteinemia, is of primordial importance. Therefore, adequate food and physical activities are necessary. If no good result is evident thereafter medicinal treatment should be prescribed. In our open random study performed in two different centres, we evaluated the efficiency and tolerance of Gemfibrozile and Phenofibrate in 77 patients with IIa, IIb, and IV stage of hyperlipoproteinaemia. The study included the patients in whom the 8-week diet gave no expected results. The evaluation of Gemfibrosile (900 mg daily) and Phenofibrate (300 m daily) efficiency lasted 12 weeks. During that time 11 patients were excluded from the study because of administration of other relevant drugs or for lack of control examinations. The efficiency was evaluated in 66 patients: 33 to Gemfibrozile and 31 to Phenofibrate. At the end of treatment the following results were obtained: decreased cholesterol level by 17% in Gemfibrozile patients and by 6% in Phenofibrate subjects; LDL-cholesterol by 15% i.e. 3% and triglycerides by 48% in Gemfibrozile cases and by 27% in Phenofibrate individuals. At the end of treatment HDL-cholesterol was increased by 29% in patients treated with Gemfibrozile and by 9% in those treated with Phenofibrate. Apoprotein A-1 was increased after Phenofibrate treatment and decreased after Gemfibrozile administration. Apoprotein B was increased in both groups. No harmful clinical or laboratory effects were observed. On the basis of these results it can be concluded that the effect of Gemfibrozile was more favourable on lipod composition in the plasma then that of Phenofibrate. No significant differences in drug tolerance were observed.

[The importance of intact parathyroid hormone determination in the evaluation of parathyroid gland function]. / Znacaj odredivanja intaktnog paratireoidnog hormona u proceni funkcije paratireoidnih zlezda.

The study investigates the importance of determining the intact parathormone in the evaluation of parathyroid gland function in different conditions of change in their function and the alteration of parathormone metabolism: primary and secondary hyperparathyroidism, hypoparathyroidism and hyperthyroidism. The role and place of intact parathormone determination in routine diagnostic schemes of calcium homeostasis disorders was reviewed by the simultaneous determination of the indicators of calcium and bone metabolism and other calcium homeostasis hormone regulators, as well as the C- and N-terminal parathormone fragments and by establishing their mutual links with the values of the intact parathormone.

[Case report of pheochromocytoma with an atypical localization]. / Slucaj feohromocitoma s atipicnom lokalizacijom.

One of the endocrine causes of arterial hypertension is pheochromocytoma, usually located in the adrenal gland medulla. Extra-adrenal tumor locations are seldom encountered, and this can considerably complicate the diagnostic procedure. If a distinct clinical manifestation exists, supported by the finding of elevated catecholamine values, it is essential to persistently and carefully search for the place of their increased production. Such an attitude is completely justified in regard to the knowledge that this endocrinologically conditioned hypertension can be permanently and successfully solved with a surgical procedure. A case of pheochromocytoma has been presented with an atypical mediastinal location, prolonged and complicated diagnostic procedure, which has been successfully solved by surgery.

[The significance of the determination of apoproteins in the diagnosis of lipoprotein metabolism disorders]. / Znacaj odredivanja apoproteina u dijagnostici poremecaja metabolizma lipoproteina.

The study, in the first place, describes the basic physical, chemical and biological characteristics of the most important apoprotein classes and their role in the metabolism of certain lipoprotein fractions. Special regard is given to the significance of determining particular apoproteins in the serum and in some lipoprotein fractions for the detection of particular disorders in lipoprotein metabolism.