Cytokines and chemokines multiplex analysis in patients with low disease activity rheumatoid arthritis.

Rheumatoid arthritis is a severe chronic autoimmune disorder that results from pathological activation of immune cells and altered cytokine/chemokine network. The aim of our study was to evaluate concentrations of chosen cytokines and chemokines in blood sera and synovial fluid samples isolated from low disease activity rheumatoid arthritis (RA) patients and osteoarthritis (OA) sufferers. Blood sera and synovial fluid samples have been obtained from 24 OA and 14 RA patients. Cytokines/chemokines levels have been determined using a Milliplex® Map 38-plex human cytokine/chemokine magnetic bead-based panel (Merck Millipore, Germany) and Luminex® MAGPIX® platform (Luminex USA). Low disease activity RA patients showed altered concentration of numerous cytokine/chemokine when compared to OA controls-they were characterized by, inter alia, increased: eotaxin/CCL11 (p = 0.037), GRO/CXCL1 (p = 0.037), IL-2 (p = 0.013), IL-4 (p = 0.017), IL-7 (p = 0.003), IL-8 (p = 0.0007) and GM-CSF (p = 0.037) serum levels, whilst MDC/CCL22 concentration was decreased in this group (p = 0.034). Eotaxin/CCL11 (p = 0.001), GRO/CXCL1 (p = 0.041), IL-10 (p = 0.003), GM-CSF (p = 0.01), IL-1RA (p = 0.0005) and VEGF (p = 0.01) concentrations in synovial fluid of RA females were also increased. Even with low disease activity score, RA patients exhibited increased concentrations of cytokines with pro- and anti-inflammatory activities, as well as numerous chemokines, growth factors and regulators of angiogenesis. Surprisingly, RA subjects also shown decreased concentration of CCL22 chemokine. The attempt to restore cytokine balance and tolerogenic environment is ineffective in RA sufferers even with good disease management. Distinguished factors could serve as possible indicators of disease progression even in low disease activity patients.

Mid-term Functional Results and Failure Analysis after First Metatarsophalangeal Joint Arthrodesis.

BACKGROUND: First metatarsophalangeal joint arthrodesis is the gold standard in the treatment of arthritis of the first MTP joint as well as an effective salvage procedure after unsuccessful primary forefoot procedures. The paper aims to present an evaluation of mid-term functional results and specify the causes of low postoperative satisfaction among patients. MATERIAL AND METHODS: 44 patients who underwent operative treatment in the years 2012-2018 were assessed with the AOFAS-MTP, EFAS and VAS scores and a radiological evaluation after at least half a year of follow-up. Multiple factors were analysed with regard to their influence on functional results and overall patient satisfaction. Our results were then compared to those of the most recent meta-analysis. RESULTS: The mean follow-up time was 27.4 months (from 6 to 82 months). The mean AOFAS-MTP score increased from 30.5 (SD 15.6) to 67.16 (SD 18.68), the mean EFAS score increased from 8.2 (SD 5.2) to 17.2 (SD 6.7), and the mean VAS score decreased from 7.6 (SD 1.6) to 3.2 (SD 2.5). Additionally, 35 patients (79.5%) were satisfied or very satisfied with the surgery, 9 patients (20.5%) reported their satisfaction as low or very low, while 6 patients (13.6%) required a revision procedure. CONCLUSIONS: Despite using methods of treatment comparable to those found in the literature and achieving similarly comparable functional and radiological results, the finding that a significant proportion of patients were not satisfied with the surgery shows the need for further investigation and optimization of operative techniques.

Vascular and cardiac function in young adults with classical congenital adrenal hyperplasia.

INTRODUCTION: Patients with classical congenital adrenal hyperplasia (CAH) have increased cardiovascular risk, but the vascular and cardiac function during longitudinal corticoids replacement therapy is not known thoroughly. MATERIAL AND METHODS: Cross-sectional study of 19 Caucasian adults with CAH (age 23.7 ± 3.8 years; twelve males) compared to 20 healthy volunteers matched for origin, sex, age, and body mass index (BMI). All of the participants were assessed for flow mediated dilatation of the brachial artery (FMD), intima-media thickness of the common carotid artery (cIMT) and common femoral artery (fIMT), standard echocardiography, and global longitudinal left ventricular function using two-dimensional speckle-tracking echocardiography (LSTE). RESULTS: The patients with CAH, compared with controls, had decreased FMD (9.4 ± 3.9 vs. 19.8 ± 5.2; p < 0.01), and the difference was still significant after correction for potential confounders. cIMT and fIMT were higher in the CAH group at baseline (for cIMT 0.47 ± 0.4 mm vs. 0.40 ± 0.03 mm; p < 0.01, for fIMT 0.47 ± 0.05 mm vs. 0.41 ± 0.04 mm; p < 0.01) but not after correction for potential confounders. The CAH subjects, compared with controls, had normal or similar left ventricular (LV) ejection fraction and LV mass index. The mean absolute value of LSTE differed in the CAH patients compared with controls (-20.5% ± 1.2 vs. -22.5% ± 1.7; p < 0.01), but it was still within the normal range. CONCLUSIONS: Young adults with CAH and glucocorticoid long-lasting treatment had impaired FMD, an insignificant increase of IMT, and subclinical changes in LV diastolic function in echocardiography.

Growth hormone/insulin-like growth factor-1 axis, calciotropic hormones and bone mineral density in young patients with chronic viral hepatitis.

INTRODUCTION: Chronic liver disease caused by HBV and HCV infections, due to its great prevalence and serious medical consequences, is at the present time a significant clinical problem. An impaired liver function can provoke severe disturbances in calcium and phosphorus homeostasis, and consequently in the bone metabolism resulting in hepatic osteodystrophy. The aim of this study was to determine whether there are significant differences in bone mineral density (BMD) and/or circadian levels of hormones connected with bone metabolism and bone turnover markers in patients with chronic viral hepatitis. MATERIAL AND METHODS: Circadian levels (AUC, area under the curve) of GH, IGF-I, IGFBP-3, osteocalcin (BGLAP), C-terminal telopeptide of type I collagen (ICTP), PTH, 25(OH)D, total calcium and total phosporus were measured in the blood of members of the study group (n = 80). BMD was assessed using the dual-energy X-ray absorptiometry method of the L2-L4 lumbar spine. Data was compared to that of healthy individuals (n = 40). RESULTS: BMD (1.05 g/cm3 vs. 1.20 g/cm3), total calcium concentration (2.20 mmol/L vs. 2.45 mmol/L), total phosphorus concentration (1.06 mmol/L vs. 1.33 mmol/L), IGF-I (AUC 3,982.32 ng/mL vs. 5,167.61 ng/mL), IGFBP-3 (AUC 725.09 ng/L vs. 944.35 ng/L), 25(OH)D (AUC 356.35 ng/mL vs. 767.53 ng/mL) and BGLAP (AUC 161.39 ng/L vs. 298 ng/L) were lower in the study group. GH (AUC 88.3 ng/mL vs. 48.04 ng/mL), iPTH (AUC 1,201.94 pg/mL vs. 711.73 pg/mL) and ICTP (AUC 104.30 µg/L vs. 54.49 µg/L) were higher in patients with hepatitis. Positive correlations were noted between bone mineral density and IGF-I, IGFBP-3, and BGLAP levels. CONCLUSIONS: Chronic viral hepatitis causes a decrease in bone mineral density. Impaired liver function disrupts homeostasis of the calcium- vitamin D-parathyroid hormone axis and provokes secondary hyperparathyroidism. Chronic viral hepatitis induces a decrease in the synthesis of IGF-I and IGFBP-3 and an increase in GH secretion. Hepatic osteodystrophy is probably caused by both changes in calciotropic hormones as well as in the somatotropin hormone axis.

Mixed germ cells tumour primarily located in the thyroid -- a case report.

Germ cells tumours most frequently occur in the gonads. Extragonadal localisation is rare and concerns mainly the mediastinum, retroperitoneum and pineal. We present the first description of a patient with a mixed germ cells tumour located primarily in the thyroid. A 35-year-old man in a good clinical condition was admitted to diagnose metastasis revealed in an X-ray of his lungs. Abnormal laboratory tests showed high concentrations of beta-HCG and LDH. Ultrasound examination revealed: hypoechogenic area 8 × 4 × 5 mm in the left testicle, and enlarged left thyroid lobe with echogenically heterogenous mass. In cytological examination of the thyroid, carcinomatous cells were found, which suggested metastasis. A diagnosis of cancerous spread of testicular cancer to the lungs and thyroid was made. The left testicle, with spermatic cord, was removed, yet in the histopathological examination no carcinomatous cells were found. Rescue chemotherapy, according to the BEP scheme (bleomycin, etoposide, cisplatin) was started, but during its course the patient died. Histopathology disclosed primary mixed germ cells tumour in the thyroid, predominantly with carcinoma embryonale and focuses of choriocarcinoma. Extragonadal germ cells tumours rarely occur in the thyroid. In medical literature, some cases of teratomas and a single case of yolk sac tumour in the thyroid have been described. The presence of choriocarcinoma was responsible for the high serum concentration of beta-HCG. Surgery of germ cells tumours proves insufficient. The conventional chemotherapy is based on cisplatin. In conclusion, extragonadal germ cells tumours are rare, but should be considered while co-existing with elevated markers such as: AFP, beta-HCG and lack of abnormalities in the gonads.

Wernicke-Korsakoff syndrome in the course of thyrotoxicosis - a case report.

Wernicke-Korsakoff syndrome (also called Wernicke's encephalopathy) is a potentially fatal, neuropsychiatric syndrome caused most frequently by thiamine deficiency. The three classic symptoms found together are confusion, ataxia and eyeball manifestations. Memory disturbances can also be symptoms. Wernicke's encephalopathy mainly results from alcohol abuse, but also from malnutrition, cancer, chronic dialysis, thyrotoxicosis and, in well-founded cases, encephalopathy associated with autoimmune thyroid disease (EAATD). The coexistence of many factors makes a proper diagnosis difficult, delays appropriate treatment and consequently reduces the chance of complete recovery. We present the case of a 53 year-old female with Wernicke's encephalopathy caused by chronic malnutrition, surgical operation, as well as thyrotoxicosis. She received treatment with intravenous thiamine administration and also anti-thyroid treatment which caused satisfactory regression of her neurological symptoms.

The relationship between cardiovascular risk estimated by use of SCORE system and intima media thickness and flow mediated dilatation in a low risk population.

BACKGROUND: The SCORE system is a simple, currently recommended method of cardiovascular risk assessment. The aim of this study is to determine the relationship between SCORE risk and intima media thickness (IMT) and flow mediated dilatation (FMD) in a low risk population. METHODS: 119 people (59 men) without known cardiovascular disease and estimated by means of SCORE system risk < 5%, were included in the study. The ultrasound method was used to assess brachial artery diameter (BAd), FMD, nitroglycerin mediated dilatation (NMD) of brachial artery and IMT of common carotid. FMD x BAd and FMD/NMD indexes representing hyperemia-induced vasodilatation independent of brachial artery properties were analyzed. RESULTS: IMT measured was 0.52 +/- 0.08 mm; FMD: 17.5 +/- 7.8%; NMD: 27.0 +/- 9.0%; FMD x BAd: 58.2 +/- 22.4, FMD/NMD: 0.64 +/- 0.19. Independent predictor for both FMD and NMD was BAd (R(2) -0.31; p < 0.001; R(2) -0.44; p < 0.001; respectively), for FMD x BAd index and FMD/NMD index was IMT (R(2) -0.04; p = 0.02; R(2) -0.04; p = 0.015) in a multivariate analysis. Risk estimated by use of the SCORE system was between 0 and 4% (median-1, 25-75 Q: 0-2). A relationship between SCORE risk and IMT (ANOVA p < 0.001), FMD (ANOVA p < 0.001), NMD (ANOVA p < 0.001), FMD x BAd index (ANOVA p = 0.017), but not FMD/NMD index (ANOVA p = 0.27), was found. CONCLUSIONS: The association of a simple stratifying scale (SCORE system) with indices of early vascular remodeling in a low risk population supports its clinical significance.

Coronary artery calcium score assessed by a 64 multislice computed tomography and early indexes of functional and structural vascular remodeling in cardiac syndrome X patients.

BACKGROUND: Regardless of normal coronary angiograms, coronary artery calcium (CAC) can be found in cardiac syndrome X (CSX) patients. According to some data, a relationship between the CAC score and markers of early atherosclerosis in CSX has been observed. Our aim was to assess whether the extent of the CAC score assessed by multislice computed tomography (MSCT) with a 64-slice system in CSX patients is related to brachial artery reactivity, intima-media thickness (IMT), and arterial compliance indexes. METHODS AND RESULTS: High-resolution ultrasound was used to measure flow-mediated dilatation (FMD) and nitroglycerin-mediated vasodilatation, as well as the following parameters of arterial structural changes: IMT, pulse wave velocity, total arterial compliance, and stiffness index. MSCT was used to assess the presence and the quantity of CAC. The study group consisted of 46 CSX patients (mean age, 56.3 +/- 9 years), whereas the control group comprised 21 healthy subjects (mean age, 54.9 +/- 7 years). The assessment of the vascular parameters showed significantly decreased FMD and increased IMT in the CSX subjects (9.06% +/- 3.2% and 0.67 +/- 0.1 mm, respectively) in comparison to the control subjects (17.42% +/- 8.4% [P = .008] and 0.57 +/- 0.2 mm [P = .021], respectively). CAC was detectable in 19 CSX patients (41%) (CAC range according to Agatston score, 2-500; mean, 101.6; median, 26.5) and in 1 control subject (4.8%) (CAC value, 13). CSX patients with detectable CAC were characterized by a significantly higher age (P = .001), lower body mass index (P = .017), and increased stiffness index (P = .020); there were no differences in FMD and IMT values. In a multivariate logistic and linear regression analysis, age was the only risk factor independently associated with the presence of CAC (P = .001) and the log(CAC + 1) value (P = .01). In the subgroup of women, log(CAC + 1) significantly correlated with age (r = 0.587, P = .002) and stiffness index (r = 0.427, P = .024), and in a borderline significant manner, it correlated with weight (r = -0.329, P = .07) and waist-hip ratio (r = 0.315, P = .07). There were no significant correlations in the male subgroup. CONCLUSIONS: Low ranges of CAC are frequently detectable in CSX patients, and the results are age-related and independent of impaired early indexes of functional and structural vascular remodeling.

[Constrictive pericarditis in the course of rheumatoid arthritis]. / Zaciskajace zapalenie osierdzia w przebiegu reumatoidalnego zapalenia stawów.

We describe a case of a patient with advanced heart failure. On the basis of clinical status, echocardiography and the results of magnetic resonance, constrictive pericarditis was diagnosed. The seropositive rheumatoid arthritis was the cause of the constriction. Constrictive pericarditis should be considered in differential diagnosis in patients with rheumatoid arthritis and heart failure.

[Patient with dyspnoea and gigantic tumor of the chest]. / Pacjentka z dusznoscia i olbrzymim guzem sciany klatki piersiowej.

We describe the patient with gigantic chest tumor admitted to the hospital because of dyspnoea. The patient was operated on after the elimination of suspicion of acute pulmonary embolism. Cardiovascular failure was caused by the huge arterial-venous fistula in the tumor and diastolic heart failure were the reasons for dyspnoea. On the basis of the microscopic examination hemangiopericytoma (HPC) was diagnosed--a mesenchymal tumor derived from pericytes. We present in our paper the rules applying to dealing with HPC.

[The general anaphylactic and local reaction after the Vipera berus's bite--case report]. / Uogólniona i miejscowa reakcja na jad zmii zygzakowatej--opis przypadku.

We describe the case of a patient with a serious general anaphylactic reaction and massive local reaction of the upper limb, which occurred after the Vipera berus's bite. In the paper, we present current knowledge of mechanisms of the Vipera berus venom's action, classification of the poisoning severity and dependent on it methods of treatment.

[Sudden cardiac death--an assessment of pre-hospital proceedings]. / Nagly zgon sercowy--ocena postepowania przedszpitalnego.

Sudden cardiac death (SCD) constitutes 13-18.5% of all natural deaths. This problem is socially and economically important because it affects often young people who are still professionally active. Many factors connected with the survival of the patients are beyond the emergency services' scope of operation. Patients do not often take seriously symptoms which occur before SCD. It has been estimated that about 40% of SCD took place without any witnesses. The witnesses, if present, cannot identify SCD and they do not supply any resuscitation. Additionally, ventricular fibrillation is getting the rare cause of cardiac arrest. The aforesaid situations, at the very beginning are responsible for the ineffectiveness of the resuscitation supplied by the emergency services.

[Acute myocardial ischemia after carbon monoxide exposure: a case report]. / Ostre niedokrwienie miesnia sercowego jako wynik zatrucia tlenkiem wegla--opis przypadku.

We describe the case of a patient who was admitted to the internal ward because of carbon monoxide poisoning. The examined level of carboxyhemoglobin measured 32%. The patient did not complain of any chest pain, but the features of myocardial hypoxia were observed in the electrocardiogram and significantly increased level of troponin T was revealed in laboratory tests. The ischaemic abnormalities ceased after normalization of carboxyhemoglobin level and the stress test was negative. Within the submitted study we report the possible interaction between carbon monoxide and cardiovascular system.

[Gastrointestinal stromal tumors of jejunum as a reason for bleeding of alimentary tract--case report]. / Guz podscieliska jelita cienkiego jako przyczyna krwawienia z przewodu pokarmowego--opis przypadku.

We describe the case of a patient who was admitted to the ward because of bleeding from the alimentary tract. Both gastroscopy and colonoscopy did not permit to establish the reason of bleeding. The patient was qualified for laparoscopy. During laparoscopy the tumour as a reason of bleeding was found and removed from jejunum. The histopathological tests confirmed the diagnosis of low malignant gastrointestinal stromal tumours (GIST). We present in our paper the rules applying to dealing with GIST.

[Sudden cardiac arrest as the first symptom of coronary heart disease--case report]. / Nagle zatrzymanie krazenia pierwszym objawem choroby wiencowej - opis przypadku.

We describe the patient at whom sudden cardiac arrest was the first symptom of coronary heart disease. In the paper, we describe factors which influence the effectiveness of resuscitation in out of hospital cardiac arrest. Applying the cardiac massage by a bystander, the presence of defibrillation rhythm and short period of time to the first defibrillation, determined the survival of the patient.

[Myocardial infarction after carbon monoxide exposure--a case report]. / Zawal miesnia sercowego w przebiegu zatrucia tlenkiem wegla pierwszym objawem choroby wiencowej--opis przypadku.

We present the case of a patient with the myocardial infarction as the result of carbon monoxide poisoning. We consider that a careful electrocardiographic and enzymatic monitoring of all patients after CO exposure is important for early diagnosis and treatment of myocardial infarction, especially because the patients often do not complain of any chest pain and ischaemic features in an electrocardiogram are withdrawing rather fast.