The bioimpedance spectroscopy as useful tool for measuring the fluid excess and fluid management in severe polytrauma patients.

Although the fluid therapy plays a fundamental role in the management of polytrauma patients (PP), a tool which could determine it appropriately is still lacking. The aim of this study was to evaluate the application of a bioimpedance spectroscopy (BIS) for body fluids volume and distribution monitoring in these patients. This prospective, observational study was performed on 25 severe PP and 25 healthy subjects. The body fluids composition was repeatedly assessed using BIS between days 3 to 11 of intensive care unit stay while the impact of fluid intake and balance was evaluated. Fluid intake correlated significantly with fluid excess (FE) in edemas, and their values were significantly higher in comparison with the control group. FE was strongly associated with cumulative fluid balance (p<0.0001; r=0.719). Furthermore, this parameter was associated with the entire duration of mechanical ventilation (p=0.001, r=0.791) independently of injury severity score. In conclusion, BIS measured FE could be useful in PP who already achieved negative fluid balance in prevention the risk of repeated hypovolemia through inappropriate fluid restriction. What is more, measured FE has a certain prognostic value. Further studies are required to confirm BIS as a potential instrument for the improvement of PP outcome.

Comet assay and its use for evaluating oxidative DNA damage in some pathological states.

The comet assay, or single-cell gel electrophoresis (SCGE), is a sensitive, rapid, relatively simple and inexpensive method for detecting DNA strand breaks in individual cells. It is used in a broad variety of applications and as a tool to investigate DNA damage and repair. The sensitivity and specificity of the assay are greatly enhanced if the DNA incubated with an enzyme, which recognizes a specific kind of DNA damage. This damage induced by oxidative stress plays a pivotal role in many diseases and in aging. This article is a critical review of the possible application of the comet assay in some pathological states in clinical practice. Most of the studies relate to evaluating the response of an organism to chemotherapy or radiotherapy with statistically significant evidence of DNA damage in patients. Other useful applications have been demonstrated for patients with heart or neurodegenerative diseases. Only a few studies have been published on the use of this method in critically ill patients, although its use would be appropriate. There are also other scenarios where the comet assay could prove to be very useful in the future, such as in predicting the likelihood of certain pathological conditions.

Novel patterns of left ventricular mechanical activity during experimental cardiac arrest in pigs.

We conducted an experimental study to evaluate the presence of coordinated left ventricular mechanical myocardial activity (LVMA) in two types of experimentally induced cardiac arrest: ventricular fibrillation (VF) and pulseless electrical activity (PEA). Twenty anesthetized domestic pigs were randomized 1:1 either to induction of VF or PEA. They were left in nonresuscitated cardiac arrest until the cessation of LVMA and microcirculation. Surface ECG, presence of LVMA by transthoracic echocardiography and sublingual microcirculation were recorded. One minute after induction of cardiac arrest, LVMA was identified in all experimental animals. In the PEA group, rate of LVMA was of 106+/-12/min. In the VF group, we identified two patterns of LVMA. Six animals exhibited contractions of high frequency (VFhigh group), four of low frequency (VFlow group) (334+/-12 vs. 125+/-32/min, p<0.001). A time from cardiac arrest induction to asystole (19.2+/-7.2 vs. 7.3+/-2.2 vs. 8.3+/-5.5 min, p=0.003), cessation of LVMA (11.3+/-5.6 vs. 4.4+/-0.4 vs. 7.4+/-2.9 min, p=0.027) and cessation of microcirculation (25.3+/-12.6 vs. 13.4+/-2.4 vs. 23.2+/-8.7 min, p=0.050) was significantly longer in VFlow group than in VFhigh and PEA group, respectively. Thus, LVMA is present in both VF and PEA type of induced cardiac arrest and moreover, VF may exhibit various patterns of LVMA.

Antioxidant defense system in familial hypercholesterolemia and the effects of lipoprotein apheresis.

Oxidative stress is thought to play an important role in the pathogenesis of disorders associated with atherosclerosis. Alpha-tocopherol is considered to be an effective lipophilic antioxidant, which protects lipid membranes against peroxidation and thus prevents cell damage by reaction with free radicals. However, measurement of alpha-tocopherol concentration in serum does not reflect the content of α-tocopherol in membranes whereas erythrocyte alpha-tocopherol may be good indicator of antioxidative status. Therefore a simple isocratic reversed phase HPLC method has been developed and validated for the determination of alpha-tocopherol in human erythrocytes in a clinical setting. The content of alpha-tocopherol in human erythrocyte membrane and lipoperoxidation were studied in patients with severe hypercholesterolemia treated by lipoprotein apheresis. The group of hypercholesterolemic patients (n = 14) treated by lipoprotein apheresis was compared to healthy adult normolipidemic controls. After lipoprotein apheresis, the content of in membrane alpha-tocopherol did not change significantly despite decreased tocopherol in serum and lipoprotein fractions. We observed significantly decreased lipoperoxidation as revealed by serum TBARS, representing end products of lipid peroxidation, which increased from third day afterwards and remained significantly higher in comparison to controls until the next LDL-apheresis. We conclude that aggressive lipid lowering procedure with lipoprotein apheresis was associated with favorable transient decrease of lipoperoxidation. Simultaneously the cell membrane bound antioxidative defense mechanisms as reflected by the content of alpha-tocopherol in human erythrocyte membrane where not depressed in spite of its decreased plasma lipid carrier. Another variables involved remain to be investigated.

Lipoprotein apheresis in the treatment of dyslipidaemia - the Czech Republic experience.

In 1984, we started using therapeutic plasmapheresis (plasma exchange) as a method of extracorporeal lipoprotein elimination for the treatment of hypercholesterolemic patients. We evaluated the results of long-term therapy in 14 patients, 8 men and 6 women. The average age was 55.6+/-13.2 (range 28-70), median 59.5 years. 14 patients were diagnosed with familial hypercholesterolemia (FH): 5 homozygous, 9 heterozygous. Ten patients in the group were treated using immunoadsorption lipoprotein apheresis and 4 using hemorheopheresis. Immunoapheretic interventions decreased LDL-cholesterol (82+/-1 %), ApoB (73+/-13 %) and even Lp(a) by 82+/-19 %, respectively. Selected non-invasive methods are important for long-term and repeated follow-up. Carotid intima-media thickness showed improvement or stagnation in 75 % of the patients. Biomarkers of endothelial dysfunction such as endoglin (in the control group: 3.85+/-1.25 microg/l, in lipoprotein apheresis-treated hypercholesterolemic individuals 5.74+/-1.47 microg/l), CD40 ligand (before lipoprotein apheresis: 6498+/-2529 ng/l, after lipoprotein apheresis: 4057+/-2560 ng/l) and neopterin (before lipoprotein apheresis: 5.7+/-1.1 nmol/l, after lipoprotein apheresis: 5.5+/-1.3 nmol/l) related to the course of atherosclerosis, but did not reflect the actual activity of the disease nor facilitate the prediction or planning of therapy. Hemorheopheresis may improve blood flow in microcirculation in familial hypercholesterolemia and also in some other microcirculation disorders via significantly decreased activity of thrombomodulin (p<0.0001), tissue factor (p<0.0001), aggregation of thrombocytes (p<0.0001) and plasma and whole blood viscosity (p<0.0001). In conclusion, lipoprotein apheresis and hemorheopheresis substantially lowered LDL-cholesterol in severe hypercholesterolemia. Our experience with long-term therapy also shows good tolerance and a small number of complications (6.26 % non-serious clinical complications).

Omentin-1 plasma levels and cholesterol metabolism in obese patients with diabetes mellitus type 1: impact of weight reduction.

BACKGROUND: Omentin-1 is an anti-inflammatory adipokine produced preferentially by visceral adipose tissue. Plasma levels of omentin-1 are decreased in obesity and other insulin-resistant states. Insulin resistance contributes to the changes of cholesterol synthesis and absorption as well. The aim of this study was to characterise omentin-1 plasma levels in obese patients with diabetes mellitus type 1 during weight reduction, and to elucidate the relationship between cholesterol metabolism and omentin-1. METHODS: Plasma levels of omentin-1 were measured in obese type 1 diabetics (n=14, body mass index >30 kg m(-2), age 29-62 years) by enzyme-linked immunosorbent assay (BioVendor). Gas chromatography with flame ionisation detector (Fisons Plc.,) was used to measure squalene and non-cholesterol sterols-markers of cholesterol synthesis and absorption (phase I). Measurements were repeated after 1 month (phase II; 1 week of fasting in the hospital setting and 3 weeks on a diet containing 150 g saccharides per day) and after 1 year (phase III) on a diet with 225 g saccharides per day. RESULTS: Omentin-1 plasma levels were stable during phases I and II, but significantly increased (P<0.001) during phase III. Omentin-1 plasma dynamics were significantly associated with plasma levels of high-density lipoprotein (P=0.005) and triacylglycerols (P=0.01), as well as with lathosterol (P=0.03). CONCLUSION: Omentin-1 plasma levels significantly increased during the weight reduction programme. Omentin-1 plasma dynamics suggest a close relationship with cholesterol metabolism.

Detection of DNA crosslinks in peripheral lymphocytes isolated from patients treated with platinum derivates using modified comet assay.

Platinum-based chemotherapeutic agents induce the formation of crosslinks in DNA, which are accepted as being responsible for the cytotoxicity of these agents. In this study, we used a modification of the alkaline comet assay for detection of the presence of DNA crosslinks in vitro caused by cisplatin, and in peripheral lymphocytes of patients with non-small cell lung carcinoma undergoing chemotherapy with platinum derivatives. The comet technique modified for the detection of DNA crosslinks was calibrated in vitro by treating HeLa cells and human lymphocytes from healthy donors with different concentrations of cisplatin. A cisplatin dose-dependent formation of DNA crosslinks was observed in in vitro measurements using 10-200 µM concentrations of cisplatin. Lymphocytes from cancer patients were also assayed for the formation and repair of DNA crosslinks. Evidence of crosslink formation and repair was observed in peripheral blood lymphocytes of all cancer patients in this study, although some inter-individual differences were observed in the response to chemotherapy and in repair of DNA crosslinks. We propose that monitoring the number of DNA crosslinks in peripheral blood lymphocytes might be a quick and sensitive method for monitoring a patient's sensitivity to this agent. Modification of the method by incubation of analysed cells with styrene oxide before crosslink analysis by comet assay extends the use of the method also to laboratories which have no facilities to use ionizing irradiation for introducing DNA breaks into the cells.

Effect of low calorie diet and controlled fasting on insulin sensitivity and glucose metabolism in obese patients with type 1 diabetes mellitus.

Obesity in T1DM patients is associated with the components of metabolic syndrome. The influence of controlled fasting and low calorie diet (LCD) on insulin sensitivity and glucose metabolism was studied in 14 obese patients with type 1 diabetes mellitus (T1DM) (42.6+/-9.4 years, BMI 32.4+/-2.1 kg m(-2)). Insulin sensitivity in obese T1DM patients was measured using a hyperinsulinemic-euglycemic clamp before fasting, immediately after 7 days of fasting, and after 21 days of LCD. Glucose oxidation and non-oxidative glucose disposal were measured before and during the clamp by indirect calorimetry. In the control group of 13 of non-obese T1DM patients (36.9+/-13.9 years, BMI 22.6+/-2.1 kg m(-2)), only one hyperinsulinemic-euglycemic clamp was performed. Obese T1DM patients lost 6.1+/-1.1 kg after fasting and maintained reduction in body weight after 21 days of LCD. Fasting transiently reduced insulin-mediated glucose disposal in the clamp (from 9.69+/-1.48 to 6.78+/-1.21 mg min(-1) kg(-1), P<0.001). This was caused by reduced glucose oxidation after the fasting period (from 2.81+/-0.52 to 0.88+/-0.98 mg min(-1) kg(-1), P<0.001). We conclude that one week of fasting transiently decreased insulin-mediated glucose disposal in T1DM patients. This was caused by reduced glucose oxidation.

[Advances in metabolism and nutrition 2011 and the route to personalized treatment]. / Pokroky v metabolizmu a výzive 2011 a cesta k personalizované lécbe.

Current model of metabolic and nutritional disorders management utilizes modern techniques that promote some of the nutritional techniques to pharmacoteherapy. This approach is demonstrated on an example of multiple organ failure and systemic inflammatory reaction managed with pharmacologically active nutritional substrates, such as arginine, glutamine, taurine, threonine and cysteine. Treatment of sarcopenia in older age is also discussed. Personalized nourishment as a component part of a wider term personalized medicine represents a new approach that requires recognition of individual differences in human genome and its expression. However, this approach also requires a change of attitude towards laboratory diagnostics and clinical practice, with patients and clinical prediction as the focal point. From this perspective, there is a need to replace current traditional laboratory tests with a new system that utilizes molecular biology and bioinformatics.

[Disturbance of synthesis of cholesterol and its precursors in clinically serious conditions]. / Porucha syntézy cholesterolu a jeho prekurzoru u klinicky závazných stavu.

OBJECTIVE: The aim of the study was to elucidate the role and importance of hypocholesterolemia in clinically serious conditions. It was a monocentric, prospective clinical study. MATERIAL AND METHODS: Two groups of patients were recruited to the study--one group were patients with coronary heart disease (CHD), who underwent miniinvasive cardiosurgical operation without extracorporeal circulatio (n = 17) and one group of patients, who sustain polytrauma (n = 19). Thirty six patients were recruited into the study. We performed the determination of sterols (total cholesterol, HDL-cholesterol, LDL-cholesterol, triacylglycerols), and their precursors (beta-sitosterol, campesterol, lathosterol, skvalen), interleukin IL-6 and cortisol in the blood serum. The short version of ACTH stimulation test was performed. The oxidative burst of granulocytes was evaluated. The blood samples were taken on the day of admission, the first, the fourth and the eighth post-operative and post-traumatic day. RESULTS: There was a significant decline of total cholesterol (TC) and LDL-cholesterol level with full recovery during observed period. There was a decline of cholesterol synthesis (lathosterol and lathosterol/cholesterol ratio) together with a decline of total cholesterol. There was a significantly negative correlation between IL-6 level and total cholesterol. Despite no confirmation of disturbance of adrenal function, there was a significantly positive correlation between lathosterol/cholesterol ratio (a de novo cholesterol synthesis marker) and cortisol level after the ACTH stimulation test. There was a significant breakdown of bactericidal function of granulocytes along with a decline of cholesterol level. CONCLUSION: There was decline of endogenous cholesterol synthesis in clinically serious conditions. The cholesterol synthesis rate is negatively influenced by IL-6 level. The rate of endogenous cholesterol synthesis positively correlated with cortisol production by the adrenals and with bactericidal function of granulocytes.

Antioxidants and vitamins in clinical conditions.

Various reactive oxygen species (ROS) may be produced from normal biochemical, essential metabolic processes or from external sources as exposure to a variety of agents presented in the environment. Lipids, proteins, carbohydrates and DNA are all capable of reacting with ROS and can be implicated in etiology of various human disorders (rheumatoid arthritis, reperfusion injury, atherosclerosis, lung diseases etc.). In the organism damage by ROS is counteracted with natural antioxidants (glutathione peroxidases, superoxide dismutases, catalase, glutathione, ubiquinol, uric acid, and essential minerals) and nutritional antioxidants from diet (i.e. vitamins E, C, carotenoids). Possible mechanisms of nutritional depletion and side effects of high intake are in the article described.

[Functional foodstuffs and diabetes--evidence and myths]. / Funkcní potraviny a diabetes--dukazy a mýty.

Functional food and nutritional supplements balance the difference between the natural nutritional requirement of man, as a slowly changing genotype, and the nutrition of today's man. This type of specifically treated food enables the nutrition of both the healthy population, where functional food eliminates certain risks and have a preventative effect (fibre, microelements), and the nutrition of the ill, which is based on the therapeutical and regulatory effect of nutrients (organ-specific nutrition).

Extracorporeal LDL cholesterol elimination (25 years of experience in CZ).

In the Czech Republic the therapy of severe familial hypercholesterolemia (FH) by extracorporeal elimination using LDL-apheresis (immunoadsorption) and hemorheopheresis is concentrated into one center. The authors evaluate the long-term therapy (3-12 years, median 7,25) in 12 patients with FH - 3 homozygous, 9 heterozygous; Fredrickson type IIa, IIb (treated: 9 by LDL-apheresis and 3 by hemorheopheresis). Immunoapheretic interventions decrease LDL-cholesterol, ApoB and even Lp(a) by about 82 +/- 1; 73 +/- 13; 82 +/- 19 %, respectively. Selected non-invasive methods are important for a long-term and repeated follow-up. Carotid intima-media thickness showed improvement or stagnation in 75% of the patients. The level of some adhesive molecules, cytokines, endoglin and some coagulation functions were measured, but no universally accepted biomarkers informing of the actual activity of the disease were found to predict and plan the therapy. A program for procedure planning with the use of Microsoft® Excel for Windows® was developed. In summary, LDL-apheresis and hemorheopheresis substantially lower LDL-cholesterol in FH. Our experience with long-term therapy also shows good tolerance and a small number of complications (5,6% of clinically irrelevant side-effects). Hemorheopheresis may improve blood flow in microcirculation in familial hypercholesterolemia and also in some other disorders of microcirculation.

Cholesterol synthesis in central nervous system of rat is affected by simvastatin as well as by atorvastatin.

OBJECTIVE: There is evidence to suppose that cholesterol-lowering drugs such as statins might confer protection against dementia, probably via modulation of cholesterol synthesis in the brain. The aim of the present study was to investigate possible influence of two lipophilic statins (simvastatin and atorvastatin) on cholesterol synthesis in selected parts of rat central nervous system (CNS). METHODS: Three groups of rats were orally treated with simvastatin (10 mg/kg b.wt.), atorvastatin (10 mg/kg b.wt.) or vehicle (aqua) for 9 days. At the end of experiment, brains (for basal ganglia, frontal cortex and hippocampus) and spinal cord were isolated and cholesterol synthesis was determined using the incorporation of deuterium from deuterated water. ANOVA with Fisher's LSD Multiple-Comparison Test and Kruskal-Wallis test were applied for statistical evaluation. P < 0.05 was considered statistically significant. RESULTS: Significant reductions of cholesterol synthesis rate were detected in both experimental groups (vs. controls) in all studied localisations. Both drugs elicited comparable effects on cholesterol synthesis rate irrespective of the examined tissue. CONCLUSIONS: This study brings additional evidence of the role of statins in the CNS cholesterol synthesis. The finding that both statins were able to lower braincholesterol synthesis without altering plasma cholesterol supports the idea of their local action inthe brain. For comparison of the effects of statins in the spinal cord and selected parts of brain, the deuterium technique was utilised for the first time.

[The use of organ specific substrates in kidney disease in a diabetic patient]. / Vyuzití orgánove specifických substrátu u onemocnení ledvin diabetika.

Diabetic nephropathy is one of the principal causes of chronic renal failure. The disease prevailingly develops in men. The incidence of diabetic nephropathy doubled from 1991 to 2001. There are different traditional dietary guidelines for the different states of diabetic nephropathy, as well as pharmacotherapy options, and, last but not least, also modern ways of application of nutritional pharmacology. Organ specific nutritional substrates - amino acids, polyunsaturated fatty acids and other components of nutrition with pharmacological effects have become indispensable in modern care for diabetic patients.

[Changes in lipid metabolism in patients in the active phase of Crohn's disease]. / Zmeny metabolizmu lipidu u pacientu v aktivní fázi Crohnovy choroby.

INTRODUCTION: Crohn's disease (CD) in its active period is accompanied by a decreased food intake and deterioration in water, mineral and metabolic balance. Lipid metabolism is known to be altered in many acute diseases, and hypocholesterolemia is a serious negative prognostic indicator. The causes of decreased serum cholesterol concentration are multiple. Simultaneous affection of both cholesterol synthesis and absorption has been reported in many sources. The changes in both the above processes can be quantified with the use of specific indicators of synthesis (cholesterol level) and absorption (sitosterol and campesterol levels). OBJECTIVE: The objective of the study was to demonstrate changes in lipid metabolism in patients with active Crohn's disease, and to find out to what extent the above phenomenon is influenced by the affection of the process of cholesterol synthesis and/or absorption in the case of detected hypocholesterolemia. MATERIAL AND METHODS: Total serum cholesterol, LDL- and HDL-cholesterol and triglyceride levels were measured on the 3rd, 14th and 28th day from admission in addition to admission analyses in 24 patients with acute manifestation of CD (CDAI - Cohn's disease activity index - over 150). Also measured were the concentrations ofsqualene, lathosterol, sitosterol and campesterol. The results were compared with a control sample of 100 voluntary blood donors. The obtained data was processed using the Sigma-stat 3.1 statistical software. RESULTS: Decreased levels of all basic lipid metabolism parameters were detected. At the same time, a statistically significant decrease in the levels of lathosterol and camposterol was recorded. The decrease in sitosterol levels was insignificant and the level of squalene was higher than in the controls. CONCLUSION: Significant changes in lipid metabolism were demonstrated in the study in patients in active phase of Crohn's disease. Also detected was statistically significant hypocholesterolemia, with altered process of cholesterol synthesis and absorption.

[Nutrition for diabetics in relation to physical exertion]. / Výziva diabetika pri fyzické zátezi.

Metabolic disorders for sugars, fats and amino-acids have a significant influence on the physical performance of type 1 and 2 diabetics. Recent studies have given a great deal of attention to the influence of the entry of fatty acids into muscles and steatosis in skeletal muscles during the onset and development of insulin resistance. Another important mechanism that influences the maintenance of muscle mass and its performance is the transport of magnesium and its availability in muscle tissue. There is a lack of magnesium in the populations of the industrially developed world and its depletion leads to disorders of muscular function, especially in diabetics.

Colon submucosal microdialysis: a novel in vivo approach in barrier function assessment - a pilot study in rats.

During shock, prognosis of a patient depends largely on intestinal barrier function. The potency of gut epithelium to represent an obstacle to toxins is determined by the blood supply. All established methods of mucosal function determination necessitate the functional involvement of bloodstream. Microdialysis allows monitoring of extracellular substances in the gut submucosa, but its potential use for gut barrier integrity assessment is unknown. Twelve rats underwent perfusion of the descending colon either with 20 % ethanol or control medium (vehicle). Both media contained equal amounts of a radioactive tracer substance ((51)Cr-EDTA). Mucosal permeability for (51)Cr-EDTA was assessed by microdialysate to luminal perfusate activity ratios. Sampling was performed using the colon submucosal microdialysis technique. The group subjected to ethanol treatment had profound macro- and microscopical alterations in perfused colonic segment associated with a significant increase in tracer permeability during ethanol exposure (2.354+/-0.298 % for ethanol as opposed to 0.209+/-0.102 % for control group, p 0.01), which remained elevated for 60 min after cessation of ethanol administration (3.352+/-0.188 % for ethanol compared to 0.140+/-0.0838 % for the control group, p 0.001). Submucosal microdialysis with radioactive tracer substance can be considered a feasible and advantageous alternative of gut barrier function estimation. Parallel monitoring of local tissue chemistry with this method remains a challenge in the future.

Urinary neopterin in patients with advanced colorectal carcinoma.

In previous studies, mostly in patients with early stage colorectal carcinoma, neopterin, an indicator of systemic immune activation, has been associated with poor prognosis. The aim of the present study was to evaluate urinary neopterin in patients with advanced or metastatic colorectal carcinoma treated with chemotherapy. A retrospective analysis was performed of urinary neopterin, determined by high-performance liquid chromatography, in 88 patients with advanced or metastatic colorectal carcinoma. Peripheral blood cell count and serum carcinoembryonic antigen (CEA) were determined in 72 patients before the start of chemotherapy. Urinary neopterin in colorectal carcinoma patients was significantly increased compared to controls, but lower than in patients with inflammatory bowel disease. Neopterin correlated significantly with serum CEA, age, peripheral blood leukocyte and platelet counts. The median survival of colorectal carcinoma patients with urinary neopterin below 214 micromol/mol creatinine was significantly longer compared to that of patients with higher neopterin concentrations (median 18 vs 5 months, log-rank test p=0.003). CEA and hemoglobin were also associated with survival in univariate analysis, but in multivariate analysis only urinary neopterin and serum CEA were independent predictors of survival. High urinary neopterin during follow-up was also predictive of poor prognosis.

[Internist's view on skin manifestations of hyperlipidemia in diabetic patients]. / Kozní projevy hyperlipidemie u diabetiku z pohledu internisty.

Xanthoma and xanthelasma are typical symptoms of lipid and lipoprotein metabolism impairment. On the basis of their incidence and morphology, it is even possible to specify the impairment type. Hypercholesterolemia or certain liver dysfunctions are characterized by slow development of surface xanthelasmas usually located on mechanically stressed regions (e.g. eyelids). Tuberous and tendinous xanthomas are typical for familiar hypercholesterolemia and are common symptoms of homozygous familiar hypercholesterolemia. Small and quickly developing eruptive xanthomas are typical for mixed hyperlipoproteinemia (secondary hyperlipoproteinemia is typical for diabetes). Mechanism of accumulation of lipids in skin morphs is similar to the development of atheroma, especially when talking about the role of modified LDL and the way of accumulation of lipids in macrophages. The following factors are very important for etiopathogenesis of skin xanthomas development: mechanical stress of tissues, increased permeability of skin capillaries and reaction of proteoglycans in sparse connective tissue. Xanthomas and xanthelasmas are typical indicators of other complicating diseases as e.g. development of acute pancreatitis during hyperlipoproteinemic crisis, aggravation of insulin resistance, and decompensation of type 2 diabetes mellitus. The therapy focuses on adjustment of dietary regime (elimination of dietary fat and concentrated saccharides); no food and sufficient hydration via infusion of crystalloid solutions is indicated in cases of serious hyperlipoproteinemic crisis. In vital indication, it is possible to perform repeated plasmapheresis (or better continual plasmapheresis) that can correct even serious hyperlipoproteinemic crises within several hours. And what is more, continual plasmapheresis can significantly reduce the period when hyperlipoproteinemic crisis might induce acute necrotizing pancreatitis. In the long run, we require that patients strictly observe their dietary regime based on the type of hyperlipoproteinemia. As for medicamentous therapy, fibrates and atorvastatin (from statin family) are the preparations of choice. It is very important not to focus on symptoms, i.e. xanthoma or xanthelasma, but fully compensate lipid metabolism impairment or the disease that underlies hyperlipoproteinemia (e.g. type 2 diabetes mellitus or metabolic syndrome). Unfortunately, it still can be seen that dermatologists, ophthalmologists or plastic surgeons remove extensive xanthelasmas, while the underlying cause is not approached diagnostically and therapeutically at all.