Neuroendocrine differentiation does not have independent prognostic value in conservatively treated prostate cancer.

In vitro studies have implicated neuroendocrine differentiation in the development of hormone resistant prostate cancer following administration of androgen blockers. Studies on clinical material are equivocal. We wished to understand the significance of neuroendocrine differentiation in our large and well-characterised cohort of clinically localised prostate cancer, treated conservatively. Immunohistochemical expression of chromogranin-A was assessed semi-quantitatively on tissue samples of 806 patients in a tissue microarray approach. The correlation of expression with 10-year prostate cancer survival was examined. Multivariate analysis including contemporary Gleason score was performed and sub-group analysis of early hormone treated patients was also undertaken. Chromogranin-A expression correlated with high Gleason score (χ(2) = 28.35, p < 0.001) and early prostate cancer death (HR = 1.61, 95 %CI = 1.15-2.27, p < 0.001). In univariate analysis, NE differentiation correlated significantly with outcome (HR = 1.61, 95 % CI 1.15-2.27, p < 0.001) However in multivariate analysis including Gleason score, chromogranin-A expression was not an independent predictor of survival (HR = 0.97, 95 %CI = 0.89-1.37, p = 0.87). Although chromogranin-A expression was higher in patients with early hormone therapy (χ(2) = 7.25, p = 0.007), there was no association with prostate cancer survival in this sub-group (p = 0.083). Determination of neuroendocrine differentiation does not appear to have any bearing on the outcome of prostatic carcinoma and does not add to the established prognostic model.

Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025.

AIMS/HYPOTHESIS: We analysed the temporal changes in the incidence of childhood type 1 diabetes and its demographic determinants in Poland from 1989 to 2004, validating the model with data from 1970 to 1989. We also estimated a predictive model of the trends in childhood diabetes incidence for the near future. METHODS: Children under 15 years with newly diagnosed type 1 diabetes mellitus and drawn from seven regional registries in Poland were ascertained prospectively using the Epidemiology and Prevention of Diabetes study (EURODIAB) criteria. The type 1 diabetes incidence rates (IRs) were analysed in dependency of age, sex, seasonality, geographical region and population density. Time trends in IR were modelled using several approaches. RESULTS: The average incidence, standardised by age and sex, for 1989 to 2004 was 10.2 per 100,000 persons per year and increased from 5.4 to 17.7. No difference was found between boys and girls, or between urban and rural regions. In children above 4 years, IR was significantly higher in the population of northern Poland than in that of the country's southern part, as well as in the autumn-winter season, this finding being independent of child sex. Based on the trend model obtained, almost 1,600 Polish children aged 0 to 14 years are expected to develop type 1 diabetes in 2010, rising to more than 4,800 in 2025. The estimates suggest at least a fourfold increase of IR between 2005 and 2025, with the highest dynamics of this increment in younger children. CONCLUSIONS/INTERPRETATION: These estimates show that Poland will have to face a twofold higher increase in childhood type 1 diabetes than predicted for the whole European population. The dramatic increase could have real downstream effects on Poland's healthcare system.

Effectiveness of the iodine prophylaxis model adopted in Poland.

OBJECTIVE: Most of the Polish territory has been classified as an iodine-deficient and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. In 1997 the obligatory model of iodine prophylaxis was implemented. Our investigations were aimed at the effectiveness of iodine prophylaxis in Poland. METHODS: We assessed urinary iodine excretion and goiter prevalence in 5663 children aged 6-12 yr. The population of children from the same 27 schools was investigated from 1992 to 1994 (1406 girls and 1244 boys) and from 1999 to 2005 (1563 girls and 1450 boys) using identical laboratory and ultrasound methods. RESULTS: We found significant increase in iodine urinary concentration (median 52 microg/l vs 93 microg/l, p<0.001) with accompanying drop in goiter prevalence (29.6% vs 5.2%, p<0.001) after implementation of iodine prophylaxis. Iodine excretion distribution changed significantly after 1997 with an increase in the percentage of children with iodine urinary concentration above 100 microg/l from 10.8% to 45.4%, respectively. A significantly higher iodine urinary concentration was observed in lowlands compared to uplands both before and after implementation of iodine prophylaxis (median, 50 microg/l vs 57 microg/l and 86 microg/l vs 114 microg/l, respectively, p<0.001). The goiter prevalence did not differ between girls and boys from 1992 to 1994 (28.8% vs 30.5%, p=0.35) and 1999 to 2005 (5.5% vs 4.9%, p=0.45). CONCLUSIONS: Implementation of the new model of iodine prophylaxis in Poland in 1997 has led to significant increase in iodine urinary concentration and decrease in goiter prevalence among Polish schoolchildren. In the youngest group of children (6-8 yr olds), prevalence of goiter decreased to 3.2%--i.e. below endemic levels.

Diabetic blindness significantly reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration targets achieved.

PURPOSE: The authors' aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved. METHODS: A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989-1994, 1995-1999, and 2000-2004. RESULTS: The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy, 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7-139.0) to 13.3/100,000 (3.8-24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5-2.2) to 0.1/100,000 (CI: -0.1-0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5-5.3) to 0.7/100,000 (CI: 0.1-1.2); p<0.001. CONCLUSIONS: The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.

Prevalence of goiter in schoolchildren--a study on the influence of adequate iodine prophylaxis in Poland.

Poland has been known as an area with iodine deficiency. Surveys carried out in 1992/1993 and 1994 revealed that the voluntary model of iodine prophylaxis introduced in 1986 was ineffective. In 1997 a new model of iodine prophylaxis based on obligatory household salt iodization has been implemented. In order to assess its effectiveness new studies were undertaken in 1999-2001. The study involved 1471 school-children aged 6-15 years from 12 sites. In every subject thyroid volume by means of ultrasound and urinary iodine concentration were assessed. The results were compared with data obtained from the same schools in the 1992/1993 survey. Between 1992/93 and 1999/2001 goiter prevalence decreased from 14.5% to 5.2% (p<0.05) and median urinary iodine concentration increased from 56 microg/l to 103 microg/l (p<0.05). A decrease in goiter prevalence was observed in 6 sites with moderate goiter endemia, whereas the changes in goiter prevalence were statistically insignificant in other 6 sites. Three sites were characterized by goiter prevalence close to 5% before and after implementing the obligatory model of iodine prophylaxis. Goiter prevalence in the remaining three sites remained within the same limit of 7-10%, in spite of observed ioduria increase. The Authors conclude that the Polish model of obligatory iodine prophylaxis ensures efficient iodine supplementation and this is confirmed by a significant increment in ioduria. The effect of this model on thyroid volume is evident in moderate goiter endemia areas. Slight changes in goiter prevalence in mild goiter endemia regions need further monitoring and considering other factors affecting thyroid volume.

Iodine-induced hyperthyroidism--an epidemiological survey several years after institution of iodine prophylaxis in Poland.

In 1997, the obligatory model of iodine prophylaxis was introduced in Poland in order to correct the existing status of mild and/or moderate iodine deficiency. In order to monitor possible side-effects of increased iodine supply, studies on iodine-induced hyperthyroidism were initiated by establishing several regional registers of hyperthyroidism. In the present paper, the results of a two-year monitoring (2000-2001) have been summarized. There are no epidemiological data on hyperthyroidism prior to starting the iodine prophylaxis, but the obtained current data are comparable to observations in other countries, made after iodine supplementation. The incidence of iodine-induced hyperthyroidism did not exceed the acceptable level, thus confirming--together with previous observations on the effectiveness of iodine prophylaxis--the adequacy of applied dose of KI (30 microg/kg NaCl), used for salt iodization in Poland.

Incidence of thyroid cancer in the selected areas of iodine deficiency in Poland.

The aim of the study was to evaluate the incidence rate (IR), trend and histotype of the differentiated thyroid cancer in the selected areas with varying iodine deficiency. The study was carried out in three areas: Krakow, (Carpathian endemic goiter area with 1.99 million mixed rural and urban population), Gliwice (Upper Silesia--moderate iodine deficiency area mostly industrial with 4.89 million inhabitants) and Olsztyn (slight iodine deficiency area, mainly rural with 0.77 million inhabitants). Between 1990 and 2001, in the study area 2691 newly diagnosed cases of malignant neoplasms of the thyroid gland were registered. In over 80% of patients it was differentiated thyroid cancer: mainly in women over 40 years, with F/M ratio 5.8. The highest percentage of papillary cancer 72.9% was observed in Olsztyn and lowest--50.0%--in Krakow and Nowy Sacz districts. In this period of time incidence rate of differentiated thyroid cancer in women increased in Kraków, Gliwice, and Olsztyn from 1.51 to 9.34 in 1998 1.27 to 5.74 in 1999 and from 2.52 to 11.35 in 2001 respectively. In the youngest (0-20 years) age group no significant increase of IR was observed. Between 1998 and 2001 the dynamics of increase of the thyroid cancer incidence markedly diminished. In conclusion it was hypothesised that an increase in IR of differentiated thyroid cancer in the study area was caused mainly by the suspension of iodine prophylaxis in 1980 and was diminished by the introduction of an obligatory model of iodine prophylaxis in 1996/1997. It was modified in terms of histotype and dynamics of increase by exposure to ionizing radiation. A very specific group at risk on the population level were women aged 20-40 years in the reproductive age exposed to iodine deficiency after suspension of iodine prophylaxis in 1980 and to radiation after the Chernobyl accident in 1986.

[Polish multicenter study on diabetes type I incidence in he age group 0-14 between 1998 and 1999]. / Wieloosrodkowe badania nad zapadalnoscia na cukrzyce typu 1 w grupie wiekowej 0-14 lat w Polsce w latach 1998-1999.

The increase in diabetes type 1 incidence observed in various centers in Poland and the need for a centralized study covering large population have resulted in the construction of a standardized registry of type 1 diabetes in 1998 within the Polish Multicenter Study in Diabetes Epidemiology. The aim of the study was to present the incidence rates of type 1 diabetes in the age group 0-14 in 7 distinct regions of Poland (Krakow, Wroclaw, Warsaw, Bialystok, Poznan, Rzeszow and Olsztyn centers) with over 30% of the Polish population at risk in 1998 and 1999. The data for the standardized registry were obtained prospectively from paediatric hospital wards and diabetes outpatient units. The incidence rates calculated in 1998 showed the highest value of 14.6 and 14.5/100,000 for Olsztyn and Warsaw, and the lowest (8.4/100,000) for Poznan center. In 1999 the highest value of 14.7/100,000 was noted in Krakow and the lowest (9.3/100,000) in Poznan center. The differences in diabetes type 1 incidence rates between age groups 0-4, 5-9 and 10-14 were found to be significant (p < 0.0005) and were also significant when incidence rates were compared between males and females in these age groups in the whole study area in 1998-1999 (p = 0.002 and p = 0.015 respectively).

[Polish multicenter study on type I diabetes incidence in the age group 15-29 between 1998 and 1999]. / Wieloosrodkowe badania nad zapadalnoscia na cukrzyce typu 1 w grupie wiekowej 15-29 lat w Polsce w latach 1998-1999.

The increase in diabetes type 1 incidence observed in various centers in Poland and the need for a centralized study covering a large population have resulted in the construction of a standardized registry of type 1 diabetes in 1998 within the Polish Multicenter Study in Diabetes Epidemiology. The aim of the study was to evaluate the incidence of type 1 diabetes in the age group 15-29 in 5 distinct regions of Poland (Krakow, Warsaw, Bialystok, Rzeszow and Olsztyn centers) with over 15% of the Polish population at risk in 1998 and 1999. The data for the standardized registry were obtained prospectively from hospital departments and diabetes outpatient units. The incidence rates calculated in 1998 showed the highest value of 11.2/100,000 for Krakow and its region, and the lowest (4.4/100,000) for Bialystok and its region. In 1999 the highest value of 12.3/100,000 was noted in Olsztyn and its region and the lowest (3.4/100,000) in Warsaw. There were significant differences in the incidence rates between the study centers were found. Incidence rates in the whole study area were significantly higher among males as compared with females in 1998 and 1999 (8.9/100,000 vs. 4.9/100,000; p = 0.0001), marked in the age groups 15-19 and 20-24 (p = 0.001 and p = 0.002 respectively). A significant increase in diabetes type 1 incidence (from 4.6/100,000 to 6.9/100,000) was found as compared with results of the "Three Cities Study" (1986-1988).

[Visual disability incidence among diabetes patients in Olsztyn province in the years 1990-1999]. / Zapadalnosc na inwalidztwo wzroku z powodu cukrzycy w województwie olsztynskim w latach 1990-1999.

UNLABELLED: The aim of the study was to estimate the incidence of visual disability. Long-term studies on visual disability have been conducted in Olsztyn Province since 1989. A standardized register has comprised 292 patients with diabetes type 1 and 2 whose visual disability resulted from diabetes. Visual disability incidence was expressed by means of a standard rate describing the number of newly diagnosed cases of visual disability per 100,000 population per year. Diabetes related visual disability incidence rate ranged from 2.52/100,000 population in 1990 to 3.08/100,000 population in 1999. For diabetes type 1, visual disability incidence rate was 1.20/100,000 population in 1990 and 1.03/100,000 population in 1999. For diabetes type 2, the rate was 1.33/100,000 population in 1990, increased to 4.66/100,000 population in 1995, and decreased to 2.05/100,000 in 1999. The rate was twice as high among women as among men. CONCLUSIONS: 1. The incidence of visual disability in 1990-1999 was 2.52 to 3.08/100,000 population on average. For type 2 diabetes it was significantly higher than for type 1 diabetes. 2. The monitoring of visual disability is a good indicator of diabetological care.

[Thyroid cancer morbidity in the Olsztyn region in 1993-1999]. / Zapadalnosc na raka tarczycy w województwie olsztynskim w latach 1993-1999.

Olsztyn region (in the north of Poland) was classified as an iodine deficiency area with moderate endemic goiter prevalence. Following Chernobyl accident, the population had one of the highest radiation doses affecting thyroid. Aims of the study were to estimate the incidence of thyroid cancer and to determine its histopathological type. The register was carried out in Olsztyn region population including each newly diagnosed case of thyroid cancer in the calendar year. The personal data of patients were collected and processed on in computer. The incidence rate was calculated as the number of newly diagnosed cases in the calendar year per 100,000 inhabitants dependent on sex and age. The results were statistically evaluated. 242 newly diagnosed cases of thyroid cancer were registered including 8 young patients (up to 18 years of age) and 234 adults. The increase in the number of cancer cases was observed year by year. The predominant type of thyroid cancer was papillary carcinoma--66.8%. Follicular carcinoma constituted 17% of cases. A statistically significant increase of incidence rate was observed in women--from 2.8/100,000 to 11.1/100,000.

Opposite effects of mast cell degranulation by compound 48/80 on peritoneal inflammation in Swiss and CBA mice.

The murine strains differ in the number of peritoneal mast cells. Degranulation of peritoneal mast cells by single injection of compound 48/80 (1.2 mg/kg) followed by zymosan-induced (2 mg/ml, 0.5 ml/mouse) peritoneal inflammation caused either inhibition or enhancement of an early influx (at 4 h of peritonitis) of exudatory leukocytes in Swiss and CBA mice, respectively. These opposite effects correspond with statistically significant differences in the number of peritoneal mast cells in the intact Swiss (11 x 10(3)) and CBA (39 x 10(3)) mice.

[The effect of an education and rehabilitation program for blind diabetics on the level of metabolic equalization]. / Wplyw kompleksowego programu edukacyjno-rehabilitacyjnego u inwalidów wzroku z powodu cukrzycy na stopien wyrównania metabolicznego.

AIM: Evaluating efficiency of the education and rehabilitation programme for patients suffering from diabetes on the level of metabolic equalization. Two modules for patients have been introduced. The first is group education conducted in groups of 20 patients. This covers basic information concerning diabetes, self-monitoring interventional actions and using the insulin-injector. The second model is repeated every three months: one-day observation in a room for daily-basis patients, which is combined with an individual educational programme and evaluation of metabolic equalization. After 6 and 24 months the level of patients knowledge was checked with the test containing 12 questions and with application of 1-5 point scale. The state of metabolic equalization was also tested, by means of evaluating the average glycaemia, serum concentration of HbA1c and the dosage of insulin. The level of patients knowledge increased after 6 months from 39 +/- 18% to 44 +/- 19%, and after 24 months by 68 +/- 21. The average glycaemia was lowered from 14.04 +/- 9.32 to 8.10 +/- 5.05 mmol/l after 24 months. The average serum cholesterol level was lowered from 6.7 +/- 1.21 to 6.51 +/- 1.39 mmol/l. At the same time there was an increase in the fractions HDL from 1.26 +/- 0.32 to 1.34 +/- 0.46 mmol/l HbA1c from 10.1 +/- 1.4% to 8.5 +/- 1.2%. The daily dose of insulin was reduced from 58.6 +/- 29.3 units a day 44.2 +/- 22.1 +/- units a day. A positive body weight reduction was observed. BMI was lowered from 30.1 +/- 3.96 to 28 +/- 5 kg/m2.

Epidemiologic estimation of goiter in children from Gdansk, Elblag, Olsztyn and Torun districts (Gdansk coordinating center).

The study comprised 1604 children (49.9% of boys and 50.1% of girls) of age between 6 and 13 years living in the districts of Gdansk, Elblag, Olsztyn and Torun. 55.5% of children were from urban area, 44.5% from rural area. This districts have been divided into 3 geographic regions. 1) Olsztyn region: 174 children and the villages near Olsztyn--178 children, 2) Seaside region: Gdansk and Elblag--358 children and 3 villages situated in the distance less than 60 km from the sea--533 children, 3) Torun region: Torun--181 children and villages near Torun--180 children. A significant relationship between the incidence of goiter and the place of living was found. The presence of goiter was observed in 9.2% of children in Gdansk and Elblag and in 23% of children in the seaside region (with the peak in Glincz village--35%). In Olsztyn region the incidence was 18.2%, in Torun region--12.5%. Among 1604 studied subjects in 263 (16.4%) with goiter, the nodular goiter was in 2.3% of cases. The lowest occurrence of goiter was noted in Gdansk and Elblag. Urinary iodine concentration in children with goiter from Gdansk and Elblag (123.1 micrograms/l) was higher than in those living in villages in the seaside region (90.8 micrograms/l). The thyroid size as measured by ultrasonography was different in children with and without goiter in each age group. In the age group of 6-8 years it was 4.8 ml in children without goiter and 6.3 ml in children with goiter, in the age group 9-10 years, 5.7 ml and 8.6 ml, in the age group 11-12 years, 6.6 ml and 10.0 ml, in children 13 years old--8.0 ml and 12.1 ml. All the children with goiter have greater body weight and height than those in the same age groups without goiter. 13.2% of studied persons consumed iodized salt. There was no difference in the incidence of goiter in children receiving and not receiving iodized salt (13.4% and 13.1% in all regions). There was also lack of relation between urinary iodine concentration and rate of consumption of iodized salt.

[A case of malignant pericardial mesothelioma]. / Przypadek zlosliwego miedzybloniaka osierdzia.

A case is described of malignant pericardial mesothelioma of epithelial type. The diagnosis was made on the basis of autopsy. The patient, a 46-year-old construction technician fell ill with symptoms of pericarditis. Initially, it was connected with a flu infection, and later with tuberculosis. During the 11-week-long treatment, a rapidly progressing worsening of health condition was observed. Death was caused by pericardial mesothelioma complicated with embolism of the pulmonary arteries.