Relapse of asthma after surgical treatment of Cushing's syndrome.

Endogenous overproduction of glucocorticoids may mask the clinical course of some inflammatory/ autoimmune disorders. In the present paper, we report a man with a history of asthma, which spontaneously remitted after 20 years of duration. Several years later, he was diagnosed with Cushing's syndrome of pituitary origin and underwent transsphenoidal microsurgery of an ACTH-producing pituitary adenoma. Shortly after tumour removal, he developed a severe asthmatic attack requiring hospitalisation and intensive treatment. We conclude that patients with Cushing's syndrome and coexisting inflammatory/autoimmune disorders should be closely supervised after normalisation of cortisol production for exacerbation of the associated disease and would eventually benefit from glucocorticoid treatment.

Cyclic Cushing's syndrome.

Because glucocorticoids are necessary to sustain life and maintain homeostasis, adrenal disorders, if not detected in a timely fashion, can have serious consequences. Cyclic Cushing's syndrome is a disease characterized by rhythmic fluctuations in glucocorticoid production. In patients with this disorder, both clinical and biochemical spontaneous remissions may occur and therefore the activity of the hypothalamic-pituitary-adrenal axis between the cycles may be undisturbed. The clinical manifestation of cyclic Cushing's syndrome may be complex and varied, differing not only between patients but also in the same patient on a daily to monthly basis. The presence of cyclic Cushing's syndrome should always be considered in patients with a clinical presentation of hypercortisolism coexisting with normal glucocorticoid plasma levels and a paradoxical response to the dexamethasone test. We here present a detailed case report on a patient diagnosed with cyclic Cushing's syndrome. We report diagnostic and treatment strategies used in our patient and their impact on the course and outcome of the disease.

Coexistence of glucocorticoid resistance and pseudohypoparathyroidism.

We report for the first time the case of a young man who developed both glucocorticoid resistance and resistance to parathyroid hormone. Treatment with high doses of dexamethasone together with administration of calcium and calcitriol resulted in a significant improvement in the patients condition. In this paper, we discuss in detail diagnostic and treatment strategies used on the patient and the impact on the course and outcome of both disorders. We associate the development of both these disorders with a possible inherited defect in the signal pathways common to glucocorticoid and parathyroid hormone receptors.

Empty sella syndrome in thyroid cancer survivor.

Empty sella syndrome is a consequence of the herniation of the subarachnoid space within the sella associated with flattering of the pituitary gland. In this paper, we describe the atypical clinical manifestation of this condition in a 27-year-old survivor of thyroid cancer. We associate the development of empty sella syndrome in this subject with normalization of levothyroxine treatment in conditions of long-lasting and inaccurately managed thyroid ablation-induced hypothyroidism. Administration of hydrocortisone and implementation of hypogonadism treatment together with the appropriate management of hypothyroidism led to a significant improvement in the patient's condition.

Genetic variants in the promoter region of the IGF-I gene as a reason for short stature.

DNA obtained from the blood cells of 88 adolescent patients with short stature, with low blood serum IGF-I concentrations, normal growth hormone (GH) secretion and normal GH receptor (GHR) structure, was analyzed in the promoter region for the IGF-I gene. A total of 24 genetic variants was detected in the DNA of 13 patients. An attempt was also made to analyze the impact of identified mutations on DNA-protein interactions using EMSA.

Growth hormone treatment in pituitary insufficiency: selected cases of children with craniopharyngioma and medulloblastoma.

PURPOSE: The work concerns the substitution treatment with growth hormone (GH) in hypopituitary children, including cases that occurred in the course of tumor disease, craniopharyngioma (CP) and medulloblastoma (MB). MATERIAL AND METHODS: The studied population concerned 117 children who presented either somatotropic or polyhormonal pituitary insufficiency (the average age was 12.6 years for girls and 13.6 years for boys). The diagnosis of somatotropic pituitary insufficiency (SPI) was based on insulin and clonidin stimulation tests evaluating GH reserve of hypophysis. The computer tomography (CT) and nuclear magnetic resonance (NMR) examinations were carried out before GH substitution in all children. The tumors (four CP cases and one case of MB) were all found in boys and they were treated with surgery and/or radiotherapy. All studied children, including CP and MB operated patients were treated with human GH (hGH)--Genotropin 16 IU, administered in subcutaneous injections. The daily dose was calculated as 0.5 IU/kg/week. RESULTS: The annual increase of children height before GH therapy was about 3.2 cm. In the first year of GH therapy the difference in children growth between the CP/MB group as compared with the rest of patients was less than 1.0 cm: 9.4 and 10.2 cm/year, resp. During the second year of hormone substitution the growth became slower: average values were 8.2 cm and 7.4 cm/year, resp. In CP and MB patients the height increase calculated as SDS values was significant (2.7 and 1.0 resp.). Control NMR examination performed in CP/MB patients treated with surgery with subsequent hGH therapy did not demonstrate any recurrence of tumor. CONCLUSIONS: After two years of hGH therapy the final height of hypopituitary children, including CP patients, nearly reached the values observed in healthy children. GH therapy did not induce a recurrence of neoplasm in CP and MB patients.

[Sanitary and relief activity of the Polish Red Cross in the repatriation and displacement action in the Western Pomeranian region]. / Dzialalnosc opiekuncza i lecznicza Polskiego Czerwonego Krzyza w akcji repatriacyjnej i przesiedlenczej na Pomorzu Zachodnim.

The final period of World War II and the first months of peace were the time of massive migration of Polish and German population. The first stage of the Poles' repatriation from the territories taken over by the USSR to the liberated parts of Poland underwent in an organizational chaos, which resulted from poor coordination between the institutions responsible for this operation. In principle, the National Repatriation Office was in charge of the repatriation action. However, where the NRO had no branches or wanted a joint action, the Polish Red Cross took a vital part in sanitary and relief activities. They were particularly crucial in the western and northern regions of Poland, which faced three massive migration currents: the influx of Polish repatriates from the USSR, the return of concentration camp prisoners, POWs and slave workers from Germany and the displacement of the German population. Colonel Jan Cialowicz gave a brief résumé of the role the Polish Red Cross played in the repatriation and displacement action: "... At the time when the foundations of the State of Poland were created in the Western Pomeranian Region, the Polish Red Cross was dressing, feeding and treating those who needed it most desperately, taking special care of the repatriates and children."

The fractal analysis of subdural haematoma.

The fractal analysis of vessel structure in the capsule of subdural haematoma has been performed. Examined material comprised 100 normal cases and 30 with long-lasting subdural haematoma. Pickworth's method and computer image processing under lmtron, Scion for Windows 98 were applied. The parallel vessels with fork-like branching were found in the subdural haematoma capsule. The essential result of the fractal analysis was that there was no difference in one-sided dimensions of subdural haematomas in contrast to differentiated one-sided dimensions of normal vessels. This finding may explain the continuous growth of subdural haematoma. The applied method allows observation of the microangioarchitecture in the capsule of subdural haematoma.

The effect of statherin and its shortened analogues on anaerobic bacteria isolated from the oral cavity.

The susceptibility (MIC) of 44 strains of anaerobic bacteria isolated from the oral cavity and 3 standard strains to statherin and its C-terminal fragments with sequences QYQQYTF, YQQYTF, QQYTF, QYTF and YTF was determined by means of plate dilution technique in Brucella agar with 5% content of defibrinated sheep's blood, menadione and hemin. The culture was anaerobic. As shown, at concentrations from 12.5 to 100 microg/ml statherin and its C-terminal fragments inhibited the growth of anaerobic bacteria isolated from the oral cavity. Peptostreptococcus strains were the most susceptible to statherin and YTF (MIC < or = 12.5 mg/ml), whereas the most susceptible to the peptides investigated were Fusobacterium necrogenes and Fusobacterium necrophorum strains: QYQQYTF, YQQYTF, QQYTF, QYTF (MIC < or = 12.5 microg/ml). Prevotella oralis, Bacteroides forsythus and Bacteroides ureolyticus strains exhibited the lowest susceptibility (MIC > 100 microg/ml). When analysing the bacteriostatic activity of statherin it should be pointed out that the concentrations of this peptide used in microbiological investigations are within the range of physiological concentrations determined for whole saliva when at rest and stimulated in healthy donors of 19-25 years of age. Since the anaerobes investigated may be involved in the diseases of periodontum, the results presented seem to have also a practical aspect, i.e. a possibility to apply the C-terminal fragments of statherin as a novel therapeutic agent, affecting favourably the oral cavity.

Fractal estimation of the senile brain atrophy.

The paper presents an attempt to fractal analysis of senile brain changes. The differences of atrophy velocity in the white and gray matter can be noticed via fractal dimension according to the described one layer approximate model. The young (34 years) and old (82 years) brains are examined and compared.

[Non-sporeforming anaerobic bacteria in bronchoalveolar lavage fluid of patients with pneumonia during the course of lung cancer]. / Niezarodnikujace bakterie beztlenowe w popluczynach oskrzelowo-pecherzykowych u chorych na zapalenie pluc w przebiegu raka pluca.

The aim of this study was to assess the occurrence of non-sporeforming anaerobes in bronchoalveolar lavage in patients with pneumonia coexisting with lung cancer. Material consisted of 40 patients with lung cancer. Bronchoalveolar lavage was performed before administration of antimicrobial treatment and obtained material was cultivated in anaerobic and aerobic conditions. Quantitative assessment of anaerobic bacteria and their susceptibility to common antimicrobial agents were also performed. Peptostreptococcus, Prevotella, Fusobacterium and Bacteroides were the most common anaerobes. Among aerobic bacteria, the most frequent were G-negative bacilli. G-negative anaerobes were susceptible to most tested agents, whereas G-positive rods were resistant to metronidazole and tinidazole. This study demonstrates presence of non-sporeforming anaerobic bacteria in lower respiratory tract infections accompanying lung cancer.

[Occurrence of non-spore forming anaerobic bacteria in the upper airways of patients with chronic obstructive pulmonary disease]. / Wystepowanie nieprzetrwalnikujacych bakterii beztlenowych w górnych drogach oddechowych u chorych z przewlekla obturacyjna choroba pluc.

The aim of this study was to assess the occurrence of anaerobic non-sporeforming bacteria upper airways flora in the exacerbation of COPD. Sputum from 35 COPD patients was sent to the laboratory in sterile, filled with CO2 containers and cultured under anaerobic conditions. In all patients bacteriological tests were positive. The most common anaerobic bacteria were as follows: Peptostreptococcus - in 28 pts, Fusobacterium - in 27 pts, Bacteroides - in 26 pts and Prevotella in 24. Less common were: Propionibacterium, Actinomyces, Eubacterium, Porphyromonas and Peptococcus. The susceptibility to most common antimicrobial agents was evaluated. All anaerobic bacteria show a significant sensitivity to amoxicillin either with clavulanic acid or ampicillin with sulbactam. Gram-positive rods were resistant to metronidazole and tinidazole.