Wpływ jednomiesięcznego podawania amlodipiny na osoczowe stężenie endoteliny-1 (ET-1) u pacjentów z nadciśnieniem tętniczym

Background Endothelium and smooth muscle protection after calcium antagonists (Ca-A) are markedly related to several mechanisms, among which the influence on endothelin- 1 (a substance regarded as the most powerful endogenous vasoconstrictor) seem to be very important. The aim of this study was to investigate the influence of amlodipine (dihydropyridine Ca-A, III generation) on plasma endothelin-1 (ET-1) and serum aldosterone (Ald) concentration in patients with essential arterial hypertension (EH). Material and methods The study population included 39 patients (18 women and 21 men) with EH in stage I according to WHO classification. Selection criteria excluded patients with a secondary form of arterial hypertension and any additional diseases influencing ET-1 plasma concentration. In all of the patients the following parameters were assessed: — SBP — systolic blood pressure; — DBP — diastolic blood pressure; — ET-1 — endothelin-1 plasma concentration; — Ald — aldosterone serum concentration; before (I study) and after 30-day treatment with amlodipine in dose 5 mg/day (II study). Results 30-day treatment with amlodipine (5 mg/day) led to: 1. Significant decrease of SBP (Mean ± SD: I study: 160.17 ± 9.76 vs II study: 131.78 ± 11.83 mm Hg, p = 0.0000001). 2. Significant decrease of DBP (Mean ± SD: I study: 93.58 ± 7.71 vs II study: 74.17 ± 10.03 mm Hg, p = 0.0000001). 3. Non-significant decrease of ET-1 conc. (Median ± S I study: 83.3 ± 23.9 vs II study: 78.7 ± 20.85 pg/ml, p = = 0.102). 4. Non-significant increase of Ald conc. (Median ± S I study: 125.9 ± 66.53 vs II study: 158.49 ± 76.15 pg/ml, p = 0.52). Conclusion 30-day treatment of essential hypertensive patients with amlodipine in dose 5 mg/day induced a nonsignificant decrease of ET-1 concentration, which may be important for the therapeutic use of amlodipine in everyday practice. However, it should be also noted that our data were collected from a relatively small group of patients (39), and probably need to be confirmed in larger population sample. Arterial Hypertension 2011, vol. 15, no 1, pages 5–12Wstęp Ochrona śródbłonka naczyniowego i mięśni gładkich naczyń w następstwie zastosowania antagonistów wapnia jest związana z wieloma mechanizmami, spośród których oddziaływanie na endotelinę- 1 (najsilniej działającą kurcząco na naczynia substancję endogenną) wydaje się niesłychanie istotne. Celem pracy była ocena wpływu amlodipiny (antagonisty wapnia, pochodnej dihydropirydyny III generacji) na osoczowe stężenie endoteliny-1 (ET-1) oraz stężenie aldosteronu (Ald) w surowicy chorych z pierwotnym nadciśnieniem tętniczym (EH). Materiał i metody Grupa badana liczyła 39 pacjentów (18 kobiet i 21 mężczyzn) z EH w stadium I wg klasyfikacji WHO. Do badań nie zakwalifikowano chorych z wtórnymi postaciami nadciśnienia tętniczego oraz chorobami mogącymi wpływać na stężenie ET-1. U wszystkich badanych oceniano następujące parametry: — SBP — ciśnienie tętnicze skurczowe; — DBP — ciśnienie tętnicze rozkurczowe; — ET-1 — stężenie ET-1 w osoczu; — Ald — stężenie aldosteronu w surowicy; przed (I badanie) i po 30 dniach podawania amlodipiny w dawce 5 mg/dobę (II badanie). Wyniki Leczenie amlodipiną przez 30 dni (5 mg/d.) spowodowało: 1. Istotne obniżenie SBP (średnia ± SD: I badanie: 160,17 ± 9,76 v. II badanie: 131,78 ± 11,83 mm Hg, p = 0,0000001). 2. Istotne obniżenie DBP (średnia ± SD: I badanie: 93,58 ± 7,71 v. II badanie: 74,17 ± 10,03 mm Hg, p = 0,0000001). 3. Nieistotne statystycznie obniżenie ET-1 (mediana ± S: I badanie: 83,3 ± 23,9 v. II badanie: 78,7 ± 20,85 pg/ml, p = 0,102). 4. Nieistotne statystycznie podwyższenie Ald (mediana ± S: I badanie: 125,9 ± 66,53 v. II badanie: 158,49 ± 76,15 pg/ml, p = 0,52). Wnioski Terapia amlodipiną przez 30 dni w dawce 5 mg/dobę u pacjentów z EH prowadziła do nieistotnego statystycznie obniżenia stężenia ET-1, co może mieć znaczenie dla zastosowania tego leku w codziennej praktyce. Jednak ograniczeniem opisywanego badania była stosunkowo niewielka liczebność grupy badanej (39 chorych), co przemawia za potrzebą poszerzenia badań. Nadciśnienie Tętnicze 2011, tom 15, nr 1, strony 5–1

Severe injuries of the pancreas and duodenum

Obrażenia trzustki i dwunastnicy występują rzadko ze względu na ich zaotrzewnowe umiejscowienie. W większości uszkodzenia tych narządów są następstwem tępych urazów brzucha. Przedstawiane w niniejszej pracy przypadki urazów trzustki i dwunastnicy stanowiły trudny problem diagnostyczny, a ostateczny zakres uszkodzeń ustalono dopiero podczas laparotomii.Injuries of the pancreas and duodenum are relatively uncommon by virtue of their retroperitoneal location. Lesions are, in the majority, due to blunt abdominal trauma. The cases of pancreatic and duodenal injuries presented in our study posed a difficult diagnostic problem and it was not until a laparotomy was performed that the final range of injuries was determined

Diagnosis and treatment of post-traumatic hypothermia in hospitals : a pilot study

Background: An unintentional drop in core body temperature of trauma victims is associated with increased mortality. Thermoregulation is impaired in these patients, especially when treated with opioids or anesthetics. Careful thermal insulation and active warming are necessary to maintain normothermia. The aim of the study was to assess the equipment and procedures for diagnosing and managing post-traumatic hypothermia in Polish hospitals. Methods: Survey forms regarding equipment and procedures on monitoring of core temperature (Tc) and active warming were distributed to every hospital that admits trauma victims in the Holy Cross Province. Questionnaires were addressed to surgery departments, intensive care units (ICUs), and operating rooms (ORs). Results: 92% of surgery departments did not have equipment to measure core body temperature and 85% did not have equipment to rewarm patients. Every ICU had equipment to measure Tc and 83% had active warming devices. In 50% of ICUs, there were no rewarming protocols based on Tc and the initiation of rewarming was left to the physician’s discretion. In 58% of ORs, Tc was not monitored and in 33% the patients were not actively warmed. Conclusions: The majority of surveyed ICUs and ORs are adequately equipped to identify and treat hypothermia, however the criteria for initiating Tc monitoring and rewarming remain unstandardized. Surgery departments are not prepared to manage post-traumatic hypothermia

Risk of chronic pancreatitis in carriers of loss-of-function CTRC variants: A meta-analysis

The digestive protease chymotrypsin C (CTRC) protects the pancreas against pancreatitis by degrading potentially harmful trypsinogen. Loss-of-function genetic variants in CTRC increase risk for chronic pancreatitis (CP) with variable effect size, as judged by the reported odds ratio (OR) values. Here, we performed a meta-analysis of published studies on four variants that alter the CTRC amino-acid sequence, are clinically relatively common (global carrier frequency in CP >1%), reproducibly showed association with CP and their loss of function phenotype was verified experimentally. We found strong enrichment of CTRC variants p.A73T, p.V235I, p.K247_R254del, and p.R245W in CP cases versus controls, yielding OR values of 6.5 (95% confidence interval (CI) 2.4-17.8), 4.5 (CI 2.2-9.1), 5.4 (CI 2.6-11.0), and 2.6 (CI 1.6-4.2), respectively. Subgroup analysis demonstrated disease association of variants p.K247_R254del and p.R245W in alcoholic CP with similar effect sizes as seen in the overall CP group. Homozygosity or compound heterozygosity were rare and seemed to be associated with higher risk. We also identified a so far unreported linkage disequilibrium between variant p.K247_R254del and the common c.180C>T (p.G60 =) haplotype. Taken together, the results indicate that heterozygous loss-of-function CTRC variants increase the risk for CP approximately 3-7-fold. This meta-analysis confirms the clinical significance of CTRC variants and provides further justification for the genetic screening of CP patients

Comparative study of virulence potential, phylogenetic origin, CRISPR-Cas regions and drug resistance of Escherichia coli isolates from urine and other clinical materials

IntroductionUrinary tract infections (UTI), among which the main etiological factor is uropathogenic Escherichia coli (UPEC, E. coli), remain an important issue for clinicians. The aim of the study was to demonstrate clear differences in the pathogenic properties of urine-derived E. coli compared to other extraintestinal E. coli clinical isolates (derived from: blood, lower respiratory tracts, sputum, reproductive tract, body fluids, perianal pus, other pus, wound, postoperative wound and other sources).MethodsThe collection of 784 E. coli isolates was collected from various materials of hospitalized patients. They were analyzed in terms of virulence-associated genes (papC, sfaD/sfaE, cnf1, usp., fimG/H, hlyA), belonging to phylogenetic groups and the presence of CRISPR-Cas regions using PCR. In addition, the epidemiological data and the antibiotic resistance profiles provided by the hospital’s microbiology department were included for statistical analyses.ResultsUrine-derived E. coli showed significantly greater virulence potential compared to other isolates, but they were generally unremarkable in terms of drug resistance. The isolates most often belonged to phylogenetic group B2. Drug resistance was negatively correlated with CRISPR 2 presence and high average virulence score, but positively correlated with CRISPR 4 presence. To the best of our knowledge, we are the first to report significant differences in sputum-derived isolates—they revealed the lowest virulence potential and, at the same time, the highest drug resistance.DiscussionIn conclusion, we demonstrated significant differences of urinary-derived E. coli compared to other clinical E. coli isolates. We would like to suggest excluding penicillins from use in E. coli infection at this time and monitoring strains with a high pathogenicity potential

The surgical treatment of rectal cancer in Poland. The findings of a multi-center observational study by the Polish Society of Surgical Oncology (PSSO-01)

Introduction. PSSO-01, a Polish prospective multi-center project on rectal cancer, started in 2016 with participation on a voluntary basis. This study evaluates the early outcome of the surgical treatment of rectal cancer in Poland according to hospital volume. Material and methods. The dataset derives from 17 clinical centers registered in the PSSO-01 study. From 2016 to 2020, the data of 1,607 patients were collected. Taking into account the number of patients enrolled in the study, the centers were divided into three categories: high volume, medium volume, and low volume. Nominal variables were compared between different categories of centers using the chi-square test. The STROBE guidelines were used to guarantee the reporting of this observational study. Results. More patients with metastatic disease were operated on in the low volume centers (p = 0.020). Neoadjuvant treatment was used in 35%, 52%, and 66% of patients operated on in low, medium, and high volume centers respectively (p < 0.001). Laparoscopic resection in medium volume centers was performed more often than in other centers (p < 0.001). The total rate of postoperative complications related to high, medium, and low centers was 22%, 26%, 18% (p = 0.044). One year following surgery, a stoma was present in 63% of patients. A defunctioning stoma following anterior resection was reversed in only 55% of patients. Anastomotic leakage was the main reason for a non-reversal diverting stoma. Conclusions. The representation of low volume centers in the PSSO-01 study was understated. However, the outcomes may show the actual situation of surgical treatment of rectal cancer in high and medium volume centers in Poland

Zasady postępowania diagnostyczno-terapeutycznego u chorych na nowotwory podścieliskowe przewodu pokarmowego (GIST) w 2010 roku

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of gastrointestinal tract. Advances in the understanding of the molecular mechanisms of GIST pathogenesis have resulted for last years in the emerging of GIST as a distinct sarcoma entity. The paper describes guidelines for diagnostics and therapy of these tumors based on scientific basis and experts’ experience, which are commonly accepted and worth to recommend. Overexpression of KIT receptor, as a consequence of mutation of protooncogene KIT, is highly specific for GIST and enable for detection by immunohistochemistry staining (CD117) in tumor specimens. It is the most important criterion in microscopic diagnostics and indications for treatment with small-molecule tyrosine kinas inhibitors. Sending material for molecular analysis is strongly recommended (for KIT and PDGFRA genotyping). Radical surgery is still the mainstay treatment for primary, localized, resectable GISTs, although high percentages of the patients after potentially curative operations develop recurrent or metastatic disease. In inoperable/ /metastatic lesions the treatment of choice is tyrosine kinase inhibitor — imatynib mesylate — the first effective systemic therapy in advanced CD117(+) GIST. Recommended initial dose should be 400 mg daily (800 mg for exon 9 KIT mutants). Monitoring of the therapy should be based on serial computed tomography imaging of abdominal cavity with the assessment of changes of tumor size and density. In case of disease progression the increase of imatynib dose to 800 mg daily is recommended and if further progression exists — sunitinib in the initial dose 50 mg daily should be introduced. Clinical trials evaluating the role of surgery in combination of imatynib and the efficacy of other molecular targeted drugs in resistant cases are ongoing. Existing data indicate beneficial role of adjuvant imatynib therapy in terms of relapse-free survival, especially in group of patients with significant risk of relapse. Presented recommendations for diagnostics and therapy of GIST should be practically implemented by physicians involved in management of GIST patients in Poland. The including GIST cases in national Clinical Registry (http://gist.coi.waw.pl) and standard treatment of patients in multidisciplinary team with expertise in GIST therapy, as well as enrollment of new cases to prospective clinical trials, are recommended. Onkol. Prak. Klin. 2010; 6, 4: 181–194Nowotwory podścieliskowe przewodu pokarmowego (GIST) są najczęstszymi nowotworami pochodzenia mezenchymalnego w obrębie przewodu pokarmowego. Dzięki postępom w diagnostyce patologiczno-molekularnej powszechnie rozpoznaje się je dopiero od kilku lat. W pracy przedstawiono zalecenia dotyczące diagnostyki i terapii tych nowotworów opracowane na podstawie danych naukowych oraz doświadczenia ekspertów, które są powszechnie akceptowane i warte rekomendacji. Nadekspresja błonowego receptora KIT, będąca następstwem mutacji protoonkogenu KIT, jest wysoce specyficzna dla GIST i możliwa do wykrycia metodami immunohistochemicznymi (CD117) w preparatach histopatologicznych z guza, stanowiąc najważniejsze kryterium w jego diagnostyce mikroskopowej i wskazaniach do leczenia drobnocząsteczkowymi inhibitorami kinaz tyrozynowych. W każdym przypadku zaleca się przesłanie materiału do badań molekularnych (w celu analizy mutacji genów KIT i PDGFRA). Radykalne leczenie operacyjne jest nadal najskuteczniejszą metodą leczenia pierwotnych GIST, jednak nowotwór ten cechuje się dużym odsetkiem nawrotów. W przypadkach zmian nieoperacyjnych/rozsianych leczeniem z wyboru jest zastosowanie inhibitora kinaz tyrozynowych — imatynibu, leku, który stanowi pierwsze efektywne leczenie systemowe w zaawansowanym GIST CD117(+). Zalecana dawka początkowa powinna wynosić 400 mg raz dziennie (800 mg dziennie w przypadku mutacji w eksonie 9 KIT). Monitorowanie leczenia musi opierać się na powtarzanym badaniu tomografii komputerowej jamy brzusznej z uwzględnieniem zmian wielkości i gęstości. W przypadku progresji zaleca się zwiększenie dawki imatynibu do 800 mg na dobę, a przy braku skuteczności — zastosowanie sunitynibu w dawce początkowej 50 mg dziennie. Trwają badania kliniczne nad ustaleniem roli leczenia chirurgicznego w skojarzeniu z imatynibem oraz skuteczności innych leków celowanych molekularnie w przypadku występowania oporności w czasie leczenia imatynibem. Dostępne dane dotyczące leczenia uzupełniającego wskazują na poprawę przeżyć wolnych od nawrotu, zwłaszcza u chorych z grupy istotnego ryzyka nawrotu choroby. Przedstawione zasady postępowania diagnostyczno-terapeutycznego powinny być wprowadzane w praktyce przez lekarzy zajmujących się chorymi na GIST w Polsce. Zaleca się rejestrowanie przypadków chorych na GIST w ramach narodowego Rejestru Klinicznego (http://gist.coi.waw.pl) oraz standardowe leczenie chorych w wielodyscyplinarnych zespołach mających doświadczenie w terapii GIST i włączanie nowych przypadków do prospektywnych badań klinicznych. Onkol. Prak. Klin. 2010; 6, 4: 181–19