[The conversion of hypothyroidism into hyperthyroidism during leflunomide with povidone iodine treatment of rheumatoid arthritis]. / Konwersja niedoczynnosci tarczycy w nadczynnosc w przebiegu leczenia reumatoidalnego zapalenia stawów leflunomidem zwierajacym powidon jodowany.

Till now there has not been reported data related to the influence of leflunomide on the thyroid gland function of the treated person. The authors described the case of woman with rheumathoid arthritis and hypothyroidism who revealed hyperthyroidism in 7 months after starting leflunomide tablets treatment containing povidone iodine as well. Also both autonomical tissue area in thyroid right lobe and hight TSHRAb level were found. Leflunomid tablets containing povidone iodine in its structure can cause hyperthyroidism in the person with previous hypothyroidism and nodular goiter, probably as a result of immunological reconversion and tissue nodular functional autonomisation. In persons with nodular goitre one should prefer free of povidone iodine leflunomide treatment and also monitor serum thyroid hormone contents and thyroid antibodies as well.

Screening to detect carbohydrate disturbances in welfare home residents in Rzeszów.

INTRODUCTION: To screen for undiagnosed type 2 diabetes and other disturbances of the glucose metabolism in welfare home residents in Rzeszów. MATERIAL AND METHODS: 478 residents of four randomly selected welfare homes in Rzeszów were initially enrolled in the study. Among them were 66 residents with previously diagnosed diabetes. Of the remaining 412 adults, 191 (39 males) aged 66.0 ± 17.7 years were enrolled in the study having completed informed consent. All subjects underwent measurements of fasting glucose levels using a glucose meter (Roche Accu-Chek Active, Mannheim, Germany). In participants whose glucose levels exceeded 99 mg/dL, an oral glucose tolerance test (OGTT) was performed. The results of OGTT were qualified as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or diabetes mellitus (DM). RESULTS: Among the 191 participants, we found 26 cases of IFG (13.6%), 25 of IGT (13.1%), and ten (5.2%) cases of newly diagnosed T2DM. CONCLUSIONS: This study highlights that in Polish welfare homes greater medical vigilance is needed in order to optimise the health of residents.

[Metabolic obesity in normal weight individuals and cardiovascular disease]. / Metaboliczna otylosc u osób z prawidlowa masa ciala a schorzrenia ukladu sercowo-naczyniowego.

Since thirty years there is growing interest in normal weight individuals who have metabolic disorders. These individuals are identified as metabolically obese but normal weight (MONW). Insulin resistance, elevated arterial blood pressure, abnormal lipid profile and sedentary style of live are known risk factors of atherosclerosis in general population. On the other hand, increased amount of visceral and subcutaneous abdominal adipose tissue is associated with increased risk of metabolic abnormalities. These abnormalities existing in MONW individuals exert an effect on increased risk of cardiovascular diseases and non insulin dependent diabetes mellitus. Identification of individuals at risk is difficult not only because no clear definition of MONW is established but also due to common belief that the cardiovascular risk in nonobese is low. The awareness of association of metabolic abnormalities in MONW with atherosclerosis should argue physicians into early screening and modification of cardiovascular risk factors in nonobese individuals.

[Bilateral ovarian luteinized thecoma associated with pregnancy--a case report]. / Ciaza powiklana obustronnym zluteinizowanym otoczkowiakiem--opis przypadku.

Hormonally active, associated with pregnancy ovarian tumors can cause some diagnostic and therapeutic problems. In the following work we present a 28-year-old primigravida in the 21st week of pregnancy who was admitted to hospital with acute abdominal pain and virilizing symptoms. Bilateral luteinized thecoma of a considerable size, secreting testosterone, was diagnosed and the woman received surgical treatment. During the operation a rupture of the left tumor was discovered. Bilateral adnexectomy was performed. After the operation the symptoms subsided. The pregnancy continued until 38 weeks gestation. A normal female fetus without virilizing symptoms was delivered by caesarean section.

[Severe depressive episode with psychotic symptoms on the basis of hypothyroidism]. / Ciezki epizod depresyjny z objawami psychotycznymi na podlozu niedoczynnosci tarczycy.

The prevalence of depressive disorders in hypothyroidism is the subject of long-term studies and controversies. The studies on big populations appear to confirm a substantially higher prevalence rate of depression in patients diagnosed with hypothyroidism. Considering interdependence between depression and hypothyroidism the possibility of coincidence of the two disorders cannot be forgotten. The aim of the work is a case of late diagnosed hypothyroidism in the course of which a severe depressive episode with psychotic symptoms occurred. A female patient, aged 39, commenced outpatient psychiatric treatment because of sleeplessness in May 2008. In the following months a lack of appetite, skin dryness and hair loss occurred. As a result of hypothyroidism diagnose she started endocrinological treatment in the Center of Thyroid Illness Treatment in Rzeszów. On the 25th of October she was admitted to Psychiatry Department of the Medical University of Lublin after taking clorazepate as a suicide attempt. While being admitted she was heavily depressed, uttered nihilistic delusions, had suicidal thoughts and was disoriented for time. From etiological point of view the situation can be considered in two categories. On one hand psychotic symptoms may have been the climax of the disturbance of the central nervous system function in long-lasting undiagnosed hypothyroidism. On the other hand, the coincidence of the two disorders cannot be excluded. The presented case implicate the role of the early diagnose of hypothyroidism for the prevention of depression.

Kikuchi-Fujimoto disease: case report.

We present the case of a 27-year-old woman with local cervical lymphadenopathy without other symptoms. Due to a gradual progression of lesions, a biopsy was performed, and a specimen excised from an enlarged lymph node was subjected to histological examination. Kikuchi-Fujimoto disease (KFD), that is histiocytic necrotizing lymhadenitis, was diagnosed. Lymphadenopathy resolved without medical treatment over 6 months. KFD should be considered in the differential diagnosis of lymphadenopathy, even though this disease rarely occurs in Poland.

[Two cases of serious hepatic injury caused by antithyroid drugs]. / Dwa przypadki istotnego uszkodzenia watroby po leczeniu tyreostatykami.

We present two cases of severe hepatotoxicity caused by antithyroid drugs in women with Graves disease. The first medication in both cases was methimazole replaced by propylhiouracil due to intolerance. The main symptom was jaundice lasting about 2 months. As a first step in the treatment we terminated the antithyroid drug administration and introduced prednisone and ursodesoksycholic acid therapy. The termination of thyrotoxicosis by means of 131 I administration had also positive influence on the course of disease. In summary we emphasise the significance of prompt discontinuation of antithyroid drug once toxic symptoms appeared and avoid replacement one thyrostatic drug for another in fovour of radioiodine treatment.

The rising incidence of type 1 diabetes in south-eastern Poland. A study of the 0-29 year-old age group, 1980-1999.

INTRODUCTION: Studies carried out over the last few years have provided information about the increase in the incidence of type 1 diabetes in different parts of the world including the European countries bordering Poland. THE AIM OF STUDY: The aim of this study was to determine the long-term trends in the incidence of type 1 diabetes over the 20 years between 1980 and 1999 and to compare the incidence during the decades preceding and following the 1989 economic and political transformation in Poland. MATERIAL AND METHODS: The registration of type 1 diabetes among people aged 0-29 was drawn up according to the DERI recommendations using three data sources. We calculated the age-standardised incidence rates for five-year age groups and determined the long-term trend in the incidence of type 1 diabetes in south-eastern Poland. RESULTS: A significant growth in the incidence of type 1 diabetes was observed among people aged 0-29 in the Rzeszów Province in the period between 1980 and 1999. The mean age-standardised incidence rate was 6.1/100,000, and a statistically significant difference was noted between the 1980s and the 1990s (5.3 [95%CI 4.5-6.0] and 6.8 [95%CI 5.9-7.6]). The male incidence of 6.7 significantly exceeded that for females--5.5/100,000. There was also a higher incidence in the group aged 0-14 in comparison with the group aged 15-29 (6.4 and 5.8/100,000 respectively). The highest incidence was found in boys aged 10-14 (11.5/100,000) and a significantly rising trend was observed in children of 0-4 years old. CONCLUSIONS: The mean incidence of type 1 diabetes among the study population was low. Nevertheless, we demonstrated a significantly increasing trend in the incidence during the 20-year observation period. The incidence in the 1990s, both in general and for males, was significantly higher when compared to the 1980s.

[Broncho-pulmonary carcinoid with the cardiac arrhythmia manifestation]. / Przypadek rakowiaka oskrzelowo-plucnego manifestujacego sie zaburzeniami rytmu serca.

We are presenting the case of a 60-year-old woman (OM ) with a bronchial-pulmonary carcinoid which the only, first and dominating symptom was paroxysmal atrial tachycardia, as well as ventricular group extrasystoles. After 1.5 years of treatment with amiodarone, the patient was admitted to hospital because of haemoptysis. In the imaging examinations of the thorax, a cavernous structure of 36 x 47 mm in the III segment of the left lung was discovered. The patient underwent urgent surgery after an episode of massive pulmonary haemorrhage--surgery included excision of the upper lobe of the left lung containing the tumour and mediastinal lymph nodes. On microscopic examination, an atypical carcinoid was diagnosed. After the surgery, arrhythmia ceased and did not return for a period of 3 following years. The current imaging examinations and determinations of 5-HIO uringexcretion acid do not indicate relapse of the tumour.

[Volume and echostructure of the thyroid and ioduria in an urban population of adults in the southeastern Polish city of Rzeszów]. / Objetosc i echostruktura tarczycy oraz joduria w miejskiej populacji osób doroslych w Rzeszowie.

The aim of this work was to determine the volume and echostructure of the thyroid and to examine urinary iodine excretion in an adult population of residents of Rzeszów, a city located in the Carpathian endemic region for goiter, after the introduction of mandatory iodine prophylaxis in 1997. 984 subjects, aged 19-60, were examined (540 females and 394 males). The mean level of urinary iodine in the examined population was 104.17 microg/l (+/- 85.22). Higher urinary iodine levels were seen in the group of males (p = 0.005) and in those who were taking medication containing iodine (p = 0.002). The mean volume of the thyroid in the examined group was 18.69 (+/- 10.01) ml and was larger in the group of males than females (p < 0.005). Nodular lesions were found in 17% of the examined thyroids and a statistically significant prevalence in the group of females (20.8%) over the group of males (11.4%) was found (p < 0.0005). The occurrence of nodules increased with age and was significantly higher in the 40-60 year age group than in the 19-25 years age group (p = 0.001). In single--and multi--factor analysis, a correlation was found between the occurrence of nodules and the female gender (r-2.04, 3.48; p < 0.005, < 0.0005) and the occurrence of nodules and the volume of the thyroid (r-1.1, 1.11; p < 0.005, < 0.0005). The occurrence of nodules did not correlate with ioduria (r-1, p = 0.8). Iodine prophylaxis was shown to be highly effective, although the examined region does not yet meet the criteria for the elimination of iodine deficiency as formulated by the ICCIDD.

Comparative efficacy of preprandial or postprandial Humalog Mix75/25 versus glyburide in patients 60 to 80 years of age with type 2 diabetes mellitus.

BACKGROUND: Humalog Mix75/25 (Mix75/25) is a novel premixed insulin containing 75% neutral protamine lispro (an intermediate-acting insulin) and 25% insulin lispro. OBJECTIVE: The purpose of this study was to compare glycemic control and hypoglycemia rates with Mix75/25 versus glyburide, and with preprandial versus postprandial Mix75/25, in patients aged 60 to 80 years with type 2 diabetes mellitus and persistent hyperglycemia on sulfonylurea therapy. METHODS: In this open-label, 16-week, parallel-group study, patients were randomized to 1 of 2 treatments: glyburide 15 mg/d (or up to the maximum daily dose) or Mix75/25. The Mix75/25 group was randomly subdivided into preprandial (immediately before breakfast and dinner) and postprandial (within 15 minutes after the start of breakfast and dinner) injection subgroups. The primary outcomes were glycemic control and rate of hypoglycemia. RESULTS: A total of 143 patients were randomized; 127 completed the study. The change in glycosylated hemoglobin (HbA(1c)) from baseline to end point was significantly greater with Mix75/25 than with glyburide (mean +/- SEM, -1.14% +/- 0.18% vs -0.36% +/- 0.15%, P = 0.001). HbA(1c) changes with preprandial and postprandial Mix75/25 were not significantly different (-1.20% +/- 0.26% vs -1.08% +/- 0.26%, P = 0.748). Fasting blood glucose (BG), 2-hour postprandial BG, and mean daily BG reductions were greater with Mix75/25 than with glyburide (P < 0.001); preprandial and postprandial Mix75/25 administration did not differ significantly with respect to any of these BG variables. The hypoglycemia rate increased with Mix75/25 by 0.17 +/- 0.02 episodes per patient per 30 days, but there was no change with glyburide (P = 0.077). Body weight increased by 1.02 +/- 0.35 kg with Mix75/25 and decreased by 0.85 +/- 0.18 kg with glyburide (P < 0.001). CONCLUSIONS: Compared with glyburide, Mix75/25 significantly improved glycemic control in older patients with type 2 diabetes mellitus, could be administered after meals without compromising glycemic control, and was well tolerated.

[Reversible thyrotoxic cardiomyopathy--report of three cases]. / Odwracalna kardiomiopatia w przebiegu tyreotoksykozy--opis trzech przypadków.

Three patients with thyrotoxicosis, atrial tachyarrhythmia and congestive heart failure despite successful treatment of hyperthyroidism revealed atrial fibrillation/flagellation and left ventricular systolic dysfunction. Congestive heart failure resolved and left ventricular systolic function normalized only after successful cardioversion to sinus rhythm. In some patients treated for hyperthyroidism, achievement of euthyroid state is not by itself sufficient to reverse left ventricular failure. Improvement after successful reversion of atrial tachyarrhythmia suggest its essential role in pathogenesis of thyrotoxic cardiomyopathy.