[Contemporary view on the pathogenesis of diabetic macroangiopathy]. / Wspólczesne spojrzenie na patogeneze makroangiopatii cukrzycowej.

Patients with IDDM and NIDDM tend to develop signs of macrovascular disease. Increased plasma glucose levels, hyperlipidaemia, the endothelial cell changes and functional disturbances, abnormal hemostasis are responsible for the development of macrovascular disease. There is a number of explanations that link plasma glucose concentrations and macrovascular diabetic disease: direct toxic effects of glucose on cell function, toxic effects of glucose on cell function and structure through glycation products, oxidative stress and effects on endothelium. Elucidation of the pathophysiology of the diabetic macrovascular complications helps to develop the effective, and preventive treatment for macrovascular disease.

[Levels of free fatty acids in plasma, K coefficient and insulin secretion stimulated by intravenous glucose load in patients with hyperthyroidism taking propranolol or acebutolol]. / Stezenie wolnych kwasów tluszczowych w surowicy, wspólczynnik tkankowego zuzycia glukozy K i sekrecja insuliny stymulowana dozylnym podaniem glukozy u chorych z nadczynnoscia tarczycy otrzymujacych propranalol lub acebutolol.

UNLABELLED: The aim of this study was to determine the relationships between plasma free fatty acids levels (FFA) and impaired glucose tolerance in hyperthyroid patients in basal condition and after propranolol and acebutolol treatment, i.e. after lipolytic blockade leading to a decrease in plasma FFA levels. 31 untreated hyperthyroid patients and 12 normal subjects of matched control group were studied. In all IVGTT was performed. 19 patients with normal K values were randomized to treated with either propranolol 160 mg daily (10 persons) or acebutolol 400 mg daily (9 persons). 12 patients with low K values were randomized to treated with either propranolol (5 persons) or acebutolol (7 persons). After 7 days on treatment a second IVGTT was carried. In all blood samples were glucose, FFA and insulin levels determined, in samples taken at 0 T3 and T4 too. T3, T4 and insulin were measured by the radioimmunoassay, glucose by the glucose oxidase method, FFA by the colorimetric method. In hyperthyroid patients with low K value significantly higher plasma concentrations of FFA were found compared to control and after propranolol or acebutolol treatment no differences in FFA levels between hyperthyroid patients and control were observed. In patients with low K value acebutolol but not propranolol normalized K value and propranolol but not acebutolol significantly decreased acute phase of insulin secretion. In patients with normal K value plasma glucose and insulin concentrations as well K value were not altered during propranolol or acebutolol treatment. CONCLUSIONS: 1. Hyperthyroid patients with low K value differ from healthy subjects higher plasma FFA levels, 2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Glucose tolerance and insulin secretion in patients with hyperthyroidism. Pathogenesis of disturbances and therapeutic consequences]. / Przemiana weglowodanowa i wydzieleni insuliny u chorych z nadczynnoscia tarczycy. Patogeneza zaburzen i konsekwencje terapeutyczne.

Abnormalities of carbohydrate metabolism have been frequently reported in hyperthyroid patients. Disturbed glucose tolerance might be due to increased hepatic glucose production, altered insulin metabolism, increased response to beta-adrenergic stimuli and elevated plasma FFA levels. These disturbances very often disappear when remission of thyrotoxicosis is attained during-treatment with thyrostatic drugs. Non-selective or selective beta 1-adrenoceptor blocking agents does not impair the glucose stimulated insulin secretion or the carbohydrate tolerance and impaired glucose tolerance disappear when glycolytic blockade is attained.

[Levels of free fatty acids in plasma, tissue utilization coefficient of glucose K and insulin secretion following intravenous glucose load in hyperthyroid patients treated with propranolol or acebutolol]. / Stezenie wolnych kwasów tluszczowych w surowicy, wspólczynnik tkankowego zuzycia glukozy K i wydzielanie insuliny stymulowane dozylnym podaniem glukozy u chorych z nadczynnoscia tarczycy otrzymujacych propranolol lub acebutolol.

The study aimed at determining relationship between plasma free fatty acid (FFA) and impaired glucose tolerance in hyperthyroid patients prior to and after the treatment with propranolol or acebutolol, i.e. following lipolytic blockade leading to a decrease in plasma FFA levels. The study included 31 untreated hyperthyroid patients and 12 normal subjects serving as a matched control group. IVGTT was performed in all subjects. Venous blood specimens were collected at 0, 3, 5, 15, 30, 60, and 120 minutes following intravenous glucose load (0.33 g/kg body weight during 3 minutes). Nineteen patients with normal K values were randomized to groups treated either with propranolol in the daily dose of 120 mg (10 patients) or 400 mg acebutolol (9 patients). Twelve patients with low K values were randomized to groups treated with either propranolol (5 patients) or acebutolol (7 patients). The second IVGTT was performed after 7 days of therapy. Glucose, FFA and insulin levels were determined in all blood samples whereas T3 and T4 were determined in samples taken at 0 minute. Plasma T3, T4 and insulin levels were assayed with radioimmunological technique, glucose--with glucose oxidase, and FFA--colorimetrically. Significantly higher plasma FFA levels were found in patients with low K values in comparison with control group. There were no differences in plasma FFA levels in both hyperthyroid patients and normal subjects. Acebutolol but not propranolol normalized K value whereas propranolol (but not acebutolol) significantly decreased acute phase of insulin secretion. Plasma glucose and insulin levels as well as K value were not altered during propranolol acebutolol therapy in patients with normal K value.(ABSTRACT TRUNCATED AT 250 WORDS)

[Impaired carbohydrate tolerance in patients with hyperthyroidism--evaluation of some influencing factors]. / Uposledzona tolerancja weglowodanowa u chorych z nadczynnoscia tarczycy--ocena wplywu niektórych czynników.

Relation between the appearance of impaired carbohydrate tolerance and such factors as the duration of hyperthyroidism, age of patients, blood serum concentrations of thyroxine, triiodothyronine and free fatty acids, as well as insulin secretion both basal and stimulated by oral and "intravenous glucose administration was studied in 62 patients with untreated hyperthyroidism. Control group consisted of 24 healthy subjects having performed oral and intravenous glucose tolerance tests. Among the studied factors, high blood serum concentrations of thyroxine and triiodothyronine, elevated concentration of free fatty acids and defective insulin secretion influenced the appearance of impaired glucose tolerance in patients with hyperthyroidism. No relation was found, however, between the impaired glucose tolerance and the duration of hyperthyroidism or the age of patients.

[TSH secretion stimulated by thyroliberin in patients with hypothyroidism receiving 1,25-hydroxyvitamin D3]. / Sekrecja TSH stymulowana tyreoliberyna u chorych z niedoczynnoscia tarczycy otrzymujacych 1,25 (OH)2 witamine D3.

The effect of 1,25-hydroxy vitamin D3 on the secretion of TSH was studied in 49 patients with primary hypothyroidism. The vitamin D3 metabolite did not cause any significant changes in the secretion of TSH both basal and stimulated with TRH in patients with untreated hypothyroidism. In those treated with the synthetic L-thyroxine it produced a significant increase in basal TSH secretion.

[Response of growth hormone to sandostatin and bromocriptine and prognostic value of prolactin levels in serum and thyroliberin test in patients with active acromegaly]. / Odpowiedz hormonu wzrostu na sandostatyne i bromokryptyne a wartosc prognostyczna stezenia prolaktyny w surowicy i testu z tyreoliberyna u chorych z aktywna akromegalia.

Usefulness of determination of blood serum prolactin concentration and the result of thyroliberin (TRH) stimulation test for predicting the magnitude of growth hormone (GH) response to the administration of sandostatin and bromocriptine has been evaluated in 14 patients with active acromegaly. No relation was found between the occurrence of hyperprolactinemia and the response of GH to the administration of sandostatin and bromocriptine. Analysis of GH secretion after TRH administration made possible the selection of a group of acromegalic patients with paradoxical increase in GH secretion in response to TRH in whom the administration of sandostatin caused a significant decrease in blood serum concentration of GH following the administration of sandostatin. TRH stimulation test had, however, no value in predicting the effect of bromocriptine on GH secretion.

[Thyroid function in patients during long-term treatment with amiodarone]. / Ocena czynnosci tarczycy u chorych przewlekle leczonych amiodaronem.

Thyroid function was evaluated in 31 patients with disturbances of heart rhythm both before and after 13 months of treatment with amiodarone. An increase in blood serum T4 concentration and transient increase (only during the first three months of treatment) in TSH concentration have been observed in almost all the patients studied. Clinically evident form of hyperthyroidism was found only in one female patient. In two patients the changes in hormone concentrations suggesting hyperthyroidism were not accompanied by clinical manifestations, and in four patients there was no clinical hypothyroidism despite hormone levels suggesting such a state. In addition to the determinations of T3, T4 and TSH also the results of TRH-TSH test played an important role in diagnosing both hypo- and hyperthyroidism.

[Effect of calcitonin on secretion of TSH stimulated by giving thyroliberin (TRH) in euthyroid subjects]. / Wplyw kalcytoniny na sekrecje TSH stymulowana podaniem tyreoliberyny (TRH) u osob z prawidlowa funkcja tarczycy.

The effect of calcitonin on TRH-induced secretion of thyrotropin was studied in 15 subjects with normal thyroid function. It was found that calcitonin has no significant effect on thyrotropin secretion both in basal conditions and following stimulation with TRH.

[Association of primary autoimmune hypothyroidism with Addison's anemia]. / Wspólistnienie pierwotnej autoimmunologicznej niedoczynnosci tarczycy i choroby Addisona-Biermera.

Intestinal absorption of vitamin B12 as measured by the Schillin test was studied in 50 patients with primary hypothyroidism of autoimmune origin. The impaired absorption of vitamin B12 was found in 24% of the patients studied, and in 6% a clinically evident form of pernicious anemia was diagnosed. The patients with hypothyroidism and simultaneous defect in absorption of vitamin B12 were characterized by more frequent occurrence of the high titer of antithyroid microsomal antibodies, higher blood serum concentration of TSH and lower blood content of hemoglobin as compared with hypothyroid patients having normal intestinal absorption of vitamin B12.

[Effect of propranolol on electrophysiologic features of the heart in patients with hyperthyroidism]. / Wplyw propranololu na wlasciwosci elektrofizjologiczne serca u chorych z nadczynnoscia tarczycy.

The effect of increasing doses of intravenously administered propranolol on electrophysiological features of heart was studied in 17 patients with untreated hyperthyroidism by using the transesophageal stimulation method. A positive and dose-dependent effect of propranolol on the studied parameters was found with the normalization of the majority of disturbances taking place after the administration of 6 mg of propranolol. This dose was safe and well tolerated by the patients. The sensitivity of the auriculo-ventricular junction to propranolol was less pronounced during the stimulated rhythm than during the sinus rhythm.

[Calcitonin test in patients with bone changes during the course of myeloma]. / Test z kalcytonina u chorych ze zmianami kostnymi w przebiegu szpiczaka mnogiego.

Hypocalcemic response following the administration of 160 units of porcine calcitonin was investigated in 14 patients with bone lesions caused by myeloma and in 9 control subjects. Significant decrease in blood serum calcium level was found in 85 per cent of myeloma patients, both in those with osteolytic bone lesions and those with generalized osteoporosis. Moreover, in all the patients a significant positive correlation was found between hypocalcemic response and the initial blood serum calcium concentration. Calcitonin administration did not cause any changes in blood serum phosphate level in myeloma patients.

[Acetylation phenotype and the changes in selected indicators of calcium-phosphate metabolism in patients with hyperthyroidism treated with propranolol]. / Fenotyp acetylacji a zachowanie sie wybranych wskazników prezemiany wapniowo-fosforanowej u chorych z nadczynnoscia tarczycy leczonych propranolem.

The occurrence of acetylation phenotype has been studied in 76 patients with untreated hyperthyroidism. In 23 of these patients having the "fast" and in 42 having the "slow" acetylation phenotype the selected parameters of calcium-phosphate metabolism have been determined before, during and after propranolol therapy lasting six days. Propranolol was administered at a dose of 160 milligrams daily. A significant decrease in the blood serum level of calcium and urinary calcium excretion following propranolol administration was found only in patients with hypercalcemia and hypercalciuria. On the other hand, a significant decrease in the urinary excretion of hydroxyproline was observed in all the patients with hyperthyroidism treated with propranolol. The effect of propranolol on the measured parameters of calcium-phosphorus metabolism was similar in hyperthyroid patients with both "fast" and "slow" acetylation phenotypes, what suggests that it does not depend on the N-acetyltransferase activity.

[Acetylation phenotype and serum levels of T3 and T4 in patients with hypertension treated with propranolol]. / Fenotyp acetylacji a zachowanie sie surowiczych stezen T3 i T4 u chorych z nadczynnoscia tarczycy leczonych propranololem.

The acetylation phenotype has been investigated in 76 patients with untreated hyperthyroidism. In 65 of these patients including 23 with fast and 42 with slow acetylation phenotype, the blood serum concentrations of thyroxine and triiodothyronine were determined before and after propranolol therapy involving propranolol administration of a dose of 160 mg per day for 6 days. The occurrence of the fast acetylation phenotype among the patients with hyperthyroidism was similar to that found in the healthy population. Propranolol therapy caused a significant decrease in the blood serum concentration of triiodothyronine only in the patients with the slow acetylation phenotype.

[Hypercalciuria in patients with diabetes mellitus type 1 and 2--studies of its pathogenesis using the oral calcium tolerance test]. / Hiperkalciuria u chorych na cukrzyce typu I i II--badania nad patogeneza z zastosowaniem testu doustnego obciazenia wapniem.

The study was aimed at the evaluation of changes in the urinary excretion of calcium in patients with diabetes of type I and II. The investigations were carried out in 34 patients with type I diabetes, 28 patients with type II diabetes and 30 control subjects having the normal glucose tolerance. The oral calcium tolerance test according to Pak was performed in all the patients and the controls. Besides normocalciuria, also hypercalciuria of renal origin, as well as hipercalciuria resulting from an elevated intestinal absorption of calcium have been found in diabetic patients. These disturbances occurred much more frequently in patients with type I diabetes, especially in those of age below 40.

[Effect of various beta-adrenolytic drugs on heart rate and changes in left-ventricular systolic time intervals in patients with hyperthyroidism and simple goiter]. / Wplyw róznych leków beta-adrenolitycznych na czestosc akcji serca i zachowanie sie podokresów skurczu lewej komory serca u chorych z nadczynnoscia tarczycy oraz wolem obojetnym.

The effects of a short-term application of various beta-adrenolytic drugs on heart rate and on the changes in subperiods of left ventricle contraction have been studied in 71 patients with untreated hyperthyroidism and in 72 patients with simple goiter. The following drugs were used: propranolol, metoprolol, atenolol, pindolol, nadolol and acebutolol. It was found that those betaadrenolytic drugs which have no sympathomimetic action cause a significant decrease in heart rate both in patients with hyperthyroidism and in those with simple goiter. The effect of these drugs on heart rate was not related to the changes in blood serum concentrations of thyroxine and triiodothyronine. None of the drugs tested influenced appreciably the contraction subperiods of left heart ventricle, both in the patients with hyperthyroidism and in those with simple goiter.