The influence of orlistat, metformin and diet on serum levels of insulin-like growth factor-1 in obeses women with and without insulin resistance.

A range of studies showed confusing data about the relationship between obesity, weight reduction and circulating total insulin-like growth factor -1 (IGF-1). The aim of the study was to compare the influence of orlistat (IO), metformin (IM), or calorie-restricted diet (LC) on IGF-1, with special respect to insulin-resistance status. One hundred and fourteen obese women aged from 18 to 40 years were divided into insulin sensitive (IS) and insulin resistant (IR) groups and received a low calorie diet (LC), or an isocaloric diet and 500 mg metformin twice daily (IM), or isocaloric diet with 120 mg orlistat three times daily (IO). Before and after the intervention anthropometric parameters, serum lipid profile, serum concentrations of alanine aminotransferase, aspartate aminotransferase, insulin, glucose, IGF-1, HOMA-IR (homeostatic model assessment), and visceral adiposity index (VAI), and their changes were registered. Although the reductions in weight and body fat were comparable in IS and IR groups, only women with IR showed a significant increase in IGF-1 concentration as a result of all interventions. We found significant positive correlations of ΔIGF-1 with initial and Δ values of: HOMA-IR, triglyceride/high-density cholesterol ratio, VAI. IR premenopausal women show significant increase in IGF-1 serum concentrations regardless the method of intervention. The increase in IGF-1 was parallel to the improvement of insulin resistance parameters.

Ex vivo detection of rat coronary endothelial dysfunction in diabetes mellitus--methodological considerations.

The present state of knowledge unequivocally indicates that chronic diabetes is associated with impaired function of coronary vessels. Langendorff retrograde perfusion is one of the most frequently employed methods to study dysfunction of coronary vasculature in animal models of diabetes mellitus. However, because of methodological discrepancies in experimental protocols, the reliability of this technique is limited. In the current study, we propose the novel technique of vasoactive drug administration and aim to evaluate its usefulness in detecting coronary dysfunction in diabetes. Using Langendorff model, we compared the results of coronary endothelium-dependent (bradykinin) and -independent (diethylamine/nitric oxide, DEA/NO) vasodilatation obtained from experimental model utilizing automatically corrected-rate infusion with commonly used, constant-rate infusion of vasoactive drug. The infusion of bradykinin at constant rate failed to reveal coronary endothelium-dependent dysfunction typical for diabetes mellitus. Induction of endothelium-independent vasodilatation by constant infusion demonstrated augmented response in diabetic hearts. The administration of bradykinin or DEA/NO at the corrected rate was associated with significantly increased maximal responses in comparison with constant infusion experiments. This phenomenon was observed particularly in the control group. We conclude that only corrected-rate infusion of vasoactive agents to actual value of coronary flow enables the reliable detection of endothelial dysfunction in diabetes mellitus.

Risk factors for atrial fibrillation in adult patients in long-term observation following surgical closure of atrial septal defect type II.

BACKGROUND: The aim of the study was to find the factors predictive for paroxysmal atrial fibrillation (AF) following surgical correction of atrial septal defect type II (ASD t.II). METHODS: 93 patients, who underwent isolated surgical closure of ASD t.II between 1990 and 2001 were included. Follow-up studies were performed 2 - 11 years after surgery. Patients were divided into two groups according to the presence of AF before and after surgery. Group AF (+) consisted of 29 and group AF (-) of 64 patients. All patients underwent echocardiography, electrocardiogram (ECG) at rest, and signal-averaged P-wave duration (PWD) in signal-averaged ECG. The following parameters were assessed in echocardiography: pulmonary artery systolic pressure, left and right atrial dimensions, right ventricular dimension, tricuspid and mitral regurgitation. RESULTS: Paroxysmal AF was observed in 27 patients before surgery and in 29 after surgery. Analyzing all potential risk factors we proved that PWD may independently predict occurrence of postoperative AF. CONCLUSION: PWD may independently predict postoperative AF in long-term follow-up after surgical correction of ASD t.II.

Safety of various methods of intensive insulin therapy in hospital condition assessed by hypoglycaemic episodes detected with the use of continuous glucose monitoring system.

PURPOSE: The aim of the study was to determine the safety of three intensive insulin therapy methods: multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) and continuous intravenous insulin infusion (IVII) used in poorly controlled type 2 diabetic patients in hospital condition. The safety of these intensive insulin therapy methods was measured by the assessment of number and duration of symptomatic and symptomfree hypoglycaemic events with use of Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed). MATERIAL AND METHODS: The study comprised 90 type 2 diabetic patients treated with conventional insulin therapy based on a twice daily injections with mean glucose profile values > 14 mmol/l. The patients were randomized into three groups according to the method of insulin treatment. The first group was treated with MDI, the second group with CSII and the third with IVII. The glucose monitoring with the use of CGMS lasted 48 hours and was conducted on the second and on the third day of intensive insulin therapy. Glucose level below 3.5 mmol/l were recognized as hypoglycaemic episode. Intensive insulin treatment was continued until "near normoglycaemia" (glucose levels 4.5-10.0 mmol/l) was achieved and then conventional insulin therapy was readministrated. RESULTS: Mean number of symptomatic hypoglycaemic events detected with CGMS was two times higher for MDI than for IVII (p = 0.04) and for CSII (p = 0.04). Number of symptomfree hypoglycaemic events detected with CGMS was higher for MDI than for IVII and CSII, but the differences were insignificant (NS). Mean duration of one symptomfree hypoglycaemic event detected with CGMS was longer in MDI than in CSII (p = 0.02) and IVII (p = 0.03). It was not observed significant differences in mean duration of one symptomatic hypoglycaemic episode between studied groups (NS). CONCLUSIONS: The results of study suggest that CSII and IVII treatment is associated with essentially lower number of symptomatic hypoglycaemic events and shorter mean duration of one symptomfree hypoglycaemic event than MDI.

A coronary artery crossed embolism of bone-marrow origin: proof of connections between pulmonary arteries and veins.

The paper describes a case of exceptionally rare crossed embolism of the coronary artery. The embolus material originated in bone-marrow released from rib fractures which occurred during resuscitation attempts. Autopsy did not reveal any anatomical abnormalities of the circulatory system, nor any disease-related changes, which could explain the occurrence of this embolism type, and therefore the only possible explanation is the presence of direct connections between pulmonary arteries and veins. The confirmation of this theory is the bone-marrow embolism of the pulmonary vein detected in the second case.

[Evaluation of some selected structural and functional parameters of red blood cells as oxidative stress markers in elderly people]. / Ocena wybranych parametrów strukturalnych i czynnosciowych krwinek czerwonych jako markerów stresu oksydacyjnego u osób w wieku podeszlym.

UNLABELLED: The ageing process induces age-related involutionary changes and leads to increased occurrence of many diseases. One of the most important theories of ageing and development of many pathologies is the free radical theory, which assumes that ageing process leads to lost of oxidative balance. THE AIM: of the research was to evaluate the degree of membrane lipid peroxidation, internal microviscosity, activity of membrane ATPase, both total and Na(+)K(+)-dependent, and markers of oxidative damage in erythrocyte membrane protein in elderly people. MATERIAL: The examination was performed on 35 people. The examined group (15 persons, mean age 71,3) consisted of healthy elderly people. The reference group was formed with younger healthy people (20 persons, mean age 55). RESULTS: Erythrocyte membrane lipid peroxidation was found stronger in the group of elderly people. Erythrocyte internal microviscosity was significantly higher in the elderly. The activity of ATPase, both total and Na(+)K(+)-dependent, appeared remarkably greater in the group of younger people. Stronger membrane lipid damage was observed in older age group, which may be implied by lower--SH group concentration, and higher W/S parameter value. CONCLUSION: The obtained results reveal that in elderly people the intensification of oxidative stress in the entire body occurs, which may be confirmed by structural and functional oxidative erythrocyte damage. This conclusion may be significant for pathogenesis of many diseases in this period of life.

[Stress echocardiography: methods, indications, clinical application]. / Echokardiografia obciazeniowa--metody, wskazania, zastosowanie kliniczne.

Stress echocardiography is an accepted alternative method for non-invasive assessment of coronary artery disease--diagnosis, risk stratification and prognosis. Myocardial ischaemia triggers a cascade of events resulting first in regional relaxation abnormalities (or diastolic dysfunction) followed by regional motion abnormalities (or diastolic dysfunction). The basic principle in stress echocardiography is to provoke myocardial ischemia by exercise, pharmacologic interventions (like dobutamine, dipirydamole, enoximone, adenosine) or less often atrial pacing and subsequently to evaluate regional wall motion abnormalities in segments vascularized by coronaries with flow--limiting stenosis. Myocardial viability can be identified at the low dose dobutamine or dipirydamole stage as a functional improvement in regions with rest dyssynergy and myocardial ischaemia can be recognized at high doses as well motion dysfunction. The ideal test for evaluation of the patient with CAD remains exercise stress testing, pharmacologic stress should be reserved only for those patients in whom optimal workload of stress cannot be obtained. This article reviews the current status of stress echocardiography in clinical practice and assesses the possible indications for the tests in a modern cardiac department.