Trudności diagnostyki pierwotnego aldosteronizmu - analiza materiału własnego

Introduction: During the last few years, increasing evidence suggests that primary aldosteronism is the cause of over 10% of arterial hypertension (AH). There are no "gold standard" methods for PA screening. The aim of study was plasma renin activity (PRA), plasma aldosterone concentration (PAC), and ARR assessment as criteria for diagnosis of PA and their usefulness in clinical practice. Material and methods: Eighty-one consecutive patients were admitted for diagnosis of primary aldosteronism: 51 women and 30 men, aged 31-69 years. In each patient, PAC and PRA were evaluated by radioimmunoassay. In 65 patients, urine concentration of catecholamine metabolites was assayed, and in 51 patients, diagnostics for hypercortisolaemia was carried out. In patients with adrenal incidentaloma, 16-row computer tomography was performed. Results: The proportion of patients with PAC over 150 pg/ml was 35% (n = 28). The number of patients with PRA under 0.07 ng/ml/h was 19 (n = 15). The ratio of patients whose values of ARR exceeded over 20, 30, 40, 50, and 180 were 55, 47, 37, 28, and 15%, respectively. Conclusions: The most common indication for primary screening was the presence of incidentally found adrenal mass. The quotient of plasma aldosterone concentration/plasma renin activity at whichever cut-off point is not effective enough for the selection of patients for further diagnostics or its cessation. (Pol J Endocrinol 2010; 61 (1): 2-5)Wstęp: W kilku ostatnich latach pojawiła się znaczna liczba doniesień sugerujących, że pierwotny aldosteronizm stanowi przyczynę ponad 10% przypadków nadciśnienia tętniczego (AH, arterial hypertension). Nie dysponujemy obecnie metodami skriningowymi pierwotnego aldosteronizmu (PA, primary aldosteronism), które można uznać za "złoty standard". Celem pracy była ocena reninowej aktywności osocza (PRA, plasma renin activity), stężenia aldosteronu w osoczu (PAC, plasma aldosterone concentration), wskaźnika aldosteron&#8211;renina (ARR, aldosterone&#8211;renin ratio) jako kryteriów rozpoznania PA i określenie ich przydatności w praktyce klinicznej. Materiał i metody: W badaniu wzięło udział 81 kolejnych pacjentów przyjetych w celu diagostyki PA: 51 kobiet i 30 mężczyzn w wieku 31-69 lat. U każdego chorego oznaczono PAC i PRA metodą radioimmunologiczną. U 65 pacjentów określono stężenie metabolitów katecholamin w moczu. U 51 przeprowadzono diagnostykę w kierunku hiperkortyzolemii. U pacjentów z incidentaloma nadnerczy wykonano 16-rzędową tomografię komputerową. Wyniki: Odsetek pacjentów z PAC > 150 pg/ml wynosił 35% (n = 28), zaś z PRA < 0,07 ng/ml/h 19% (n = 15). Wartości ARR przekraczające kolejne punkty odcięcia 20, 30, 40, 50 i 180 stwierdzono u odpowiednio 55, 47, 37, 28 i 15% badanych. Wnioski: Najczęstszym wskazaniem do skriningu w kierunku pierwotnego aldosteronizmu stanowiła obecność przypadkowo wykrytego guza nadnerczy. Iloraz aldosteronemii do aktywności reninowej osocza, bez względu na przyjęty punkt odcięcia, nie stanowi wystarczającego kryterium, będącego podstawą do prowadzenia dalszej diagnostyki lub jej zaniechania. (Endokrynol Pol 2010; 61 (1): 2-5

Dermoscopic findings in extragenital lichen sclerosus

Lichen sclerosus (LS), also known as lichen sclerosus et atrophicus is a chronic inflammatory dermatosis of unknown aetiology. It has both genital and extragenital presentations, nevertheless genital forms significantly outnumber extragenital LS. Dermoscopy is noninvasive diagnostic tool traditionally employed in pigmented lesions, however its usefulness in inflammatory skin conditions is becoming continuously more meaningful. Although the clinical diagnosis of fully developed LS rarely causes difficulties, unusual presentations require differentiation from the diseases such as lichen planus, morphea, extramammary Paget disease, SCC and others. In these cases histopathology contributes to the diagnosis. Studies on the use of dermoscopy in LS are sparse, nevertheless some dermoscopic features of LS has been described

Melanin and lipofuscin as hallmarks of skin aging

Discoloration are symptoms of skin aging. They are connected with presence of melanin and lipofuscin, whose excess and abnormal distribution in the skin cause dark spots to appear. Melanin is formed under the influence of tyrosinase during melanogenesis. Its content changes with age, which may be a result of menopause. Lipofuscin is another example of the age pigment. It is composed of proteins, lipids and carbohydrates. It is described as an age pigment because its content increases with age. The formation and accumulation of lipofuscin is inevitable and leads to cell and homeostasis dysfunction because it reduces the proteasome activity

The effect of the preparation method of Pd-doped cobalt spinel on the catalytic activity in methane oxidation under lean fuel conditions

Although NG is one of the cleanest hydrocarbon fuels, the complete oxidation of CH4 from compressed NG-fuelled engines is still an open issue. Catalysts for CH4 combustion undergo very demanding conditions: they must resist thermal and mechanical shocks and exhibit high activity, as CH4 molecules show great stability and the temperature of the exhausts in CNG vehicles is relatively low (it seldom exceeds 500°C). Many catalysts have been used for the combustion of CH4, with platinum and palladium being the most common active metals, although also perovskites or perovskites with noble metals have been employed. Recently attention has increasingly focused on the development of cobalt oxide based powders. These powders have high potential for use as catalysts, gas sensors, magnetic materials, rechargeable batteries, pigments for ceramics, solar energy absorbers and electrochemical devices. Cobalt(II,III) oxide Co3O4 and cobalt(II) oxide (CoO) particles are largely prepared by a wide assortment of wet chemical techniques like freeze drying, spray pyrolysis, co-precipitation, solubility-controlled synthesis, sol-gel. On the contrary, there are not many studies of cobalt oxide particles obtained by solution combustion synthesis (SCS)

The effect of the preparation method of Pd-doped cobalt spinel on the catalytic activity in methane oxidation under lean fuel conditions

Although NG is one of the cleanest hydrocarbon fuels, the complete oxidation of CH4 from compressed NG-fuelled engines is still an open issue. Catalysts for CH4 combustion undergo very demanding conditions: they must resist thermal and mechanical shocks and exhibit high activity, as CH4 molecules show great stability and the temperature of the exhausts in CNG vehicles is relatively low (it seldom exceeds 500°C). Many catalysts have been used for the combustion of CH4, with platinum and palladium being the most common active metals, although also perovskites or perovskites with noble metals have been employed. Recently attention has increasingly focused on the development of cobalt oxide based powders. These powders have high potential for use as catalysts, gas sensors, magnetic materials, rechargeable batteries, pigments for ceramics, solar energy absorbers and electrochemical devices. Cobalt(II,III) oxide Co3O4 and cobalt(II) oxide (CoO) particles are largely prepared by a wide assortment of wet chemical techniques like freeze drying, spray pyrolysis, co-precipitation, solubility-controlled synthesis, sol-gel. On the contrary, there are not many studies of cobalt oxide particles obtained by solution combustion synthesis (SCS

Acne fuminans in the course of oral isotretinoin treatment. Presentation of cases

Isotretinoin is considered a gold standard in treating severe cases of acne. It brings lots of benefits but on the other hand can cause series of undesirable side-effects. I present 2 cases of patients suffering from acne fulminans in the course of treatment with oral isotretinoin. Acne fulminans is a very severe systemic disease and its course is difficult to foresee. The most important is rapid diagnosis and implementation of treatment. Systemic corticosteroids combined with isotretinoin or high does of antibiotics are the most effective. The alternative methods are: dapsone, infliximab

Acne fulminans in the course of oral isotretinoin treatment. Presentation of cases

Isotretinoin is considered a gold standard in treating severe cases of acne. It brings lots of benefits but on the other hand can cause series of undesirable side-effects. We present 2 cases of patients suffering from acne fulminans in the course of treatment with oral isotretinoin. Acne fulminans is a very severe systemic disease and its course is difficult to foresee. The most important is rapid diagnosis and implementation of treatment. Systemic corticosteroids combine

Changes in concentration of visfatin during four weeks of inpatient treatment of alcohol dependent males

Introduction: Visfatin is a protein which belongs to the adiponectines, and exhibits insulinomimetic properties. A high concentration of visfatin may be directly related to an ongoing inflammatory process in the body. The aim of this study was to assess changes in the concentration of visfatin in relation to the intensity of alcohol craving and selected clinical characteristics in patients with alcohol dependency. Materials and methods: The thirty-seven males enrolled in the study had been hospitalised due to alcohol dependence in the addiction treatment unit. In the first week and after four weeks of treatment, clotted blood samples were obtained to determine the concentration of visfatin and other biochemical parameters. Next, patients were divided into two groups – group 1 with a decrease and group 2 with an increase in the concentration of visfatin during the four weeks of treatment. The study used a socio-demographic and clinical scale, the Short Alcohol Dependence Data questionnaire (SADD) and an analogue alcohol craving scale. Additionally, the study considered measurements of waist-to-hip circumference ratio (WHR) and biochemical blood parameters. Results: There was a statistically significant difference between group 1 and group 2 in the concentration of visfatin (35.5 ng/ml vs 146 ng/ml) after four weeks of inpatient alcohol dependence treatment. Discussion: Perhaps different pathophysiological processes were taking place (including inflammatory response) in patients with high and low visfatin concentration in the initial stage of the trial. Conclusions: The dynamic of change in the concentration of visfatin during four weeks of abstinence is not associated with a reduction in craving for alcohol at the time and is associated with alcohol drinking and liver functioning

Być zdolnym – wspierać zdolnych

Praca recenzowana / peer-reviewed paperByć zdolnym – wspierać zdolnych to książka szczególna. Zawiera teksty napisane przez nauczycieli – uczestników studiów podyplomowych Praca z uczniem zdolnym. Stanowią oni pierwszą grupę specjalistów w zakresie rozpoznawania, opieki i wspierania uczniów zdolnych w województwie świętokrzyskim. Takie kadry są szczególnie potrzebne wobec zmian w systemie pracy ze zdolnymi, wdrażanych w szkołach i placówkach od roku szkolnego 2011/2012. Studia były realizowane w ramach projektu Benild – Doskonalenie Świętokrzyskich Kadr Oświaty, współfinansowanego ze środków Unii Europejskiej w ramach Europejskiego Funduszu Społecznego, na Uniwersytecie Jana Kochanowskiego w Kielcach. Celem studiów było nabywanie przez nauczycieli kompetencji w obszarze identyfikacji i wspierania uczniów zdolnych