Changes in bone density during long-term administration of low-molecular-weight heparins or acenocoumarol for secondary prophylaxis of venous thromboembolism.

BACKGROUND: Indications for long-term anticoagulation are expanding. Osteoporosis is a complication which can develop after prolonged treatment with unfractionated heparin and is probably multifactorial. Data on osteoporosis associated with low-molecular-weight heparins (LMWH) are contradictory. Vitamin K participates in bone metabolism and since oral anticoagulants antagonize vitamin K, their use may also increase the risk of osteoporosis. AIM: To assess and compare the effects of long-term secondary venous thromboembolic prophylaxis with LMWH or acenocoumarol on bone structure. METHODS: We assessed bone mineral density (BMD) by densitometry in 86 patients receiving LMWH or acenocoumarol for 3-24 months. The initial BMD was compared to the final result expressed as the percentage difference. The Z-score was also assessed and defined for individual patients as the number of standard deviations of BMD from its ideal value calculated for age and sex groups. RESULTS: Excessive decrease in BMD was evidenced, which seemed to relate to the duration as well as type of treatment. At 1 and 2 years of follow-up, the mean decrease in BMD of the femur was 1.8% and 2.6% in patients on acenocoumarol and 3.1 and 4.8% in patients on enoxaparin, respectively. CONCLUSIONS: Long-term exposure to treatment and prophylaxis of venous thromboembolism cause a modest but progressive decrease in BMD, more evident in patients on LMWH than on acenocoumarol. It might be advisable to perform densitometry before starting long-term anticoagulation and to repeat it every 12 months, especially in patients with concomitant risk factors for osteoporosis in order to identify patients in need of its prophylaxis.

The conversion of thyroxine to triiodothyronine in the lung: comparison of activity of type I iodothyronine 5' deiodinase in lung cancer with peripheral lung tissues.

UNLABELLED: Triiodothyronine (T3) is the main active hormone, which is derived 20% from the thyroid gland and 80% from peripheral tissues. Thyroxin--5' deiodinases play a leading role in maintaining appropriate T3 concentrations in the different cells and organs: including the lung. The deiodinases present in pneumocytes were found to be localised in endoplasmatic reticulum. Aims of this study were: 1. To estimate activities of Type I and Type II iodothyronine 5' deiodinases (DI, DII) in two histological types of lung cancer. 2. To investigate possible differences in DI and DII activities between tumour tissue and peripheral lung tissue. 3. To study whether DI and DII activities are related to the extent of the disease process and grade of differentiation of lung cancer. MATERIAL: We studied 44 patients undergoing thoracotomy due to lung cancer. Histologically: 23 pts--squamous cell cancer, 21 pts adenocarcinoma. In all patients both tumour and peripheral lung tissue were studied. DI activity was measured in pmol 1251- released from 125 IrT3/min/mg of proteins, DII activity--in fmol 125I- released from 125IT4/hour/mg of protein. RESULTS: In most specimens DI and DII activities were observed. DI activity in specimens from lung peripheral tissue was: 3.3-58.3 pmol/min/mg of protein (mean 22.20) and in lung cancer tissue was: 2.0-44.7 pmol/min/mg of proteins (mean 13.3). DII activity in lung peripheral tissue ranged from 19 to 242 fmol/h/mg protein (mean 94.4) and in lung cancer ranged from 21 to 253 fmol/h/mg protein (mean 107.9). CONCLUSIONS: 1. Conversion of T4 to T3 occurs also in the lung. 2. The activity of DI is statistically significantly lower, in lung cancer than in peripheral lung tissue (13.3 +/- 9.5 vs 22.20 +/- 13.4 pmol/min/mg protein) respectively, p < 0.001. 3. DII activity in lung is present and similar in peripheral lung and lung cancer tissue. 4. There is a non-significant trend for correlation of DI activity and grade of differentiation (G1-G3) of tumour tissue and stage of lung cancer. Abbreviations' list: T3--triiodothyronine, T4--thyroxine, FT4--free thyroxine, rT3--revers triiodothyronine TSII--Thyroid Stimulating Hormone Type I lodothyronine 5'deiodinase = type I 5'deiodinase = 5'DI = DI Type II Iodothyronine 5'deiodinase = typeII 5'deiodinase = 5'DII = DII E.S.S.--Euthyroid Sick Syndrome, hDII = human type II iodothyronine deiodinase HDII-b, hDII-c = two novel splice variants SCC--Squamous Cell Cancer, A--adenocarcinoma, BMI--Body Mass Index BSA--Bovine Standard Albumin, DTT-1,4 Dithio-L-treitol, PTU--Propylothiouracil TCA--Tricholoroacetic Acid, TNM--Tumour Nodule Metastases (class.) G1-G3-grade of differentiation, COPD--Chronic Obstructive Pulmonary Disease.

[Invasive aspergillosis in autopsy material of patients treated at the Institute of Tuberculosis and Chest Diseases during the years 1993-2000]. / Inwazyjna aspergiloza w materiale autopsyjnym u chorych leczonych w Instytucie Gruzlicy i Chorób Pluc w latach 1993-2000.

The aim of this paper is an analysis of clinical documentation and results of autopsy of 21 patients (pts) who died of invasive aspergillosis (IA) in the Institute of Tuberculosis and Chest Diseases in years 1993-2000 and the assessment of predisposing factors for IA. In 17 pts IA was the main and in other 4 only an accessory cause of death. All pts were treated with corticosteroids and/or cytostatic drugs--because of lung cancer (11 pts), cancer in other site (2 pts), haematologic disorders (2 pts), Wegener's granulomatosis (1 pt), polymyositis (1 pt), idiopathic pulmonary fibrosis (1 pt) and other diseases (3 pts). In 15 out of 21 pts granulocytopenia was revealed (from 0.008 x 10(9)/L to 0.82 x 10(9)/L) on an average one month before death. In 15 pts IA was limited to the lungs, in 6 others there were also fungal lesions in brain, kidneys, liver, spleen and heart. Pts with disseminated form of IA had significantly lower granulocyte count and were treated with higher doses of corticosteroids than others. Immunosuppressive drugs and granulocytopenia can be regarded as predisposing factors. Fatal course of IA depended also on the late diagnosis.

[LGM inferior vena cava filters--observation of 79 patients]. / Filtry LGM zakladane do zyly glównej dolnej--obserwacja 79 chorych.

The aim of the study was to assess effectiveness and safety of the LGM inferior vena cava (IVC) filters in patients with venous thromboembolic disease. In the Department of Internal Medicine of Institute of Tuberculosis and Lung Diseases in Warsaw 79 LGM IVC filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (pe) despite anticoagulation--17 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy--11 pts, contraindications for thrombolytic and/or anticoagulant treatment--5 pts, massive pe--14 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)--30 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery--24 pts. Each filter placement was preceded by cavography. The diagnostic procedures (mainly ultrasonography) were performed after 3-6 and 12 months in the first year then once yearly during follow-up period. Oral anticoagulants (OA) or low-molecular-weight heparins (LMWH) were instituted in the majority of patients. 58 patients are still alive, 21 patients died. Only two non-fatal episodes of recurrent pe were documented. Other complications were rare and insignificant. We have not observed excess rate of recurrent deep venous thrombosis nor thrombosis at the filter site. The LGM IVC filters are effective and safe in such selectively chosen group of patients.

[Secondary anticoagulant prophylaxis with low molecular heparins or oral anticoagulants and bone mineral density]. / Wtórna profilaktyka przeciwzakrzepowa z uzyciem heparyn drobnoczasteczkowych lub doustnych antykoagulantów a mineralizacja kosci.

A broad spectrum of indications for low molecular weight heparin (LMWH) requires an assessment of side effects especially during prolonged administration. There are common risk factors for venous thromboembolism (VTE) and osteoporosis; heparin is "the drug of choice" for VTE treatment. The aim of our study was to assess the effect of treatment and prophylaxis with LMWH (enoxaparine sodium) and oral anticoagulant (acenocoumarol) for bone structure. Material consists of in- and outpatients. 49 densitometries were performed in 31 patients (in 15 cases double examination). We observed a decrease of bone mineral density in comparison to the initial examination in most cases: mean change of bone mass for examined areas was 3.05%.

[Usefulness of analyzing ANCA changes for diagnosis of Wegener's granulomatosis]. / Przydatnosc oznaczania miana ANCA dla diagnostyki ziarniniakowatosci Wegenera.

UNLABELLED: ANCA were described in 1982 as sensitive and specific markers for active Wegener's granulomatosis (WG). We analysed the results of ANCA test performed in 298 patients hospitalized in Institute of Tuberculosis and Lung Diseases in the period 1990-1998 because of different symptoms and syndromes of respiratory system which could be symptoms of WG. Presence of c-ANCA, p-ANCA and other not well defined types of ANCA in the titer greater than 1:40 in the serum was regarded as positive result of test. We found it in 60 patients. In 47 WG pts ANCA were present in 40 of 42 pts with active disease and 1 of 5 in remission. Further 19 positive results were found in a group of 251 patients with other diseases: 1 of 4 pts with Churg-Strauss syndrome, 1 of 2 with pulmonary renal syndrome, 5 of 28 with connective tissue diseases, 1 of 21 with tuberculosis, 1 of 23 with sarcoidosis, 1 of 6 with histiocytosis, 3 of 11 with hypersensitivity pneumonitis, 1 (lymphoma) of 34 with neoplasms, 1 of 20 with pulmonary fibrosis, 1 of 8 with cardiac failure, 1 of 5 with pleural fluid, 1 of 10 pneumoconiosis and toxic reactions (after furagin), 1 of 6 with BOOP. Sensitivity of ANCA test in our material is 87%, specificity = 95%, and positive prevalence accuracy is 68%. It means that 32% of the patients with positive results could be inappropriate treated as WG. CONCLUSION: ANCA test could be not used as a screening test. Results of ANCA test alone cannot be used as basis for treatment. ANCA test is a helpful tool in diagnosing of WG.

[Secondary prophylaxis of venous thromboembolism: analysis of 49 fatal cases]. / Wtórna profilaktyka przeciwzakrzepowa zylnej choroby zakrzepowo-zatorowej: analiza 49 zgonów.

The analysis of 49 fatal cases of venous thromboembolism--VTE (15% of total ambulatory patients number during long observation was performed. The advanced age of patients, multiple risk factors, underlying circulatory and respiratory tract diseases, malignancies, previous episodes of VTE especially with secondary pulmonary hypertension were the most important factors determining fatal prognoses in those patients.

[Secondary ambulatory prophylaxis of venous thromboembolism: outcome of patients who were lost to follow-up]. / Wtórna ambulatoryjna profilaktyka zylnej choroby zakrzepowo-zatorowej: losy chorych, którzy utracili kontakt z przychodnia.

We have attempted to determine the outcome of 87 out-patients who were lost from follow-up. Several factors have been assessed: causes of lost from follow-up duration of oral anticoagulation, recurrent venous thromboembolic events, cause of death (if applicable).

[Wegener's granulomatosis. Three cases with different clinical courses]. / Ziarniniakowatosc Wegenera. Opis 3 przypadków o odmiennym obrazie kliniczym.

Three cases of Wegener's granulomatosis are presented. In every case the different clinical picture was observed. In the first case dominated the pulmonary changes and fingers necrosis. In that case the excellent therapeutic effect of etoposide was observed. In the second case the most important clinical sings illustrated severe renal insufficiency. The third case demonstrated pericardial and skin changes. The significance of early diagnosis and early institution of proper therapy was discussed.

[Euthyroid sick syndrome in patients with respiratory failure]. / Euthyroid sick syndrome u chorych w stanie niewydolnosci oddechowej.

There have been report concerning decrease of thyroid gland hormones concentrations in respiratory diseases. The aim of this study was to estimate the influence of severe respiratory failure (RF) of Intensive Care Unit (ICU) patients on blood serum thyroid hormone concentration. The tests were carried out in 22 ICU- patients with partial or total RF in whom the relationship between PO2, pH, PCO2 and TT3, TT4, FT3, rT3, FT4 was tested. The obtained data indicate that: 1. In patients with RF ESS takes place, 2. ESS seems to be related to the decrease of PO2; statistically significant correlation between TT3, FT3, rT3, and PO2 exist, 3. The increase of TT3 serum concentration directly correlates with the improvement of clinical state of patients. The lowest TT3 concentrations were observed in "ante mortem" patients. This fact suggest the prognostic value of TT3, TT4 concentration measurements in patients with RF.

[Examination of thyroxine conversion to triiodothyronine in the lungs (preliminary report)]. / Badanie konwersji tyroksyny do trijodotyroniny w plucach (doniesienie wstepne).

Presence of triiodothyronine's receptors has been confirmed in majority of cells constituting lung architecture. The purpose of the investigation is the estimation of the conversion of the thyroxine through examination the activity of deiodinase I in the lung. The material in the form of 2.0-3.0 g lung pieces was taken in therapeutic thoracotomy from patients with emphysema, and in non-small cell lung cancer (n.s.c.l.c.). The examination of the activity of deiodinase I in chronic pulmonary diseases can help to show one of the elements of euthyroid sick syndrome (e.s.s.). The correlation between the deiodinase I activity in neoplastic tissue and the extent of the process of n.s.c.l.c. may provide the necessary data about the behaviour of triiodothyronine receptors which are closely related to oncogenes. The deiodinase I activity may be considered as a marker of lung cancer.

[Recurrent infections of the respiratory tract and staphylococcal pneumonia with septic shock and total respiratory failure in a patient with histiocytosis X]. / Nawracajace zakazenia w drogach oddechowych oraz gronkowcowe zapalenie pluc ze wstrzasem septycznym i calkowita niewydolnoscia oddechowa u chorej z histiocytoza X.

Disseminated pulmonary infiltrates, cutaneous lesions and diabetes insipidus in a female patients with a history of recurrent pneumothorax and persistent respiratory tract infections suggested the diagnosis of histiocytosis X. The pathological examination of a biopsy lung tissue specimen confirmed that diagnosis. In the course of treatment many dangerous complications were observed. The intensive therapy including artificial ventilation (24 days) was fully effective and settle the beneficial clinical outcome.

[Plasma antithrombin III activity in patients with pulmonary thromboembolism]. / Aktywnosc antytrombiny III w osoczu u chorych z choroba zakrzepowo-zatorowa.

A decreased plasma antithrombin III activity has been noted in 12 out of 20 patients. In 2 patients it was most probably congenital defect, whereas in the remaining 10 patients--acquired. The observed disorders in the activity of antithrombin III with particular reference to anticoagulant therapy have been discussed.

[Relationship between clinical classification of hyperthyroidism for three grades of severity and level of triiodothyronine (T3) and thyroxine (T4) concentrations in serum]. / Wspólzaleznosc pomiedzy klinicznym podzialem na trzy stopnie zaawansowania nadczynnosci tarczycy a stezeniem trójjodotyroniny (T3) I tyroksyny (T4) w surowicy.

The aim of the study was to assess the relationship between the clinical classification of hyperthyroidism based on the 3-degree score system and T3 and T4 serum concentration. 161 patients with Graves disease or toxic goiter were studied. By comparing the number of scores separating the 3 subgroups in relation to the severity of disease with T3 and T4 serum concentration of tyreotoxic patients we found a very high statistically significant correlation. We also found the marked (by +50%) statistically significant increase in the serum T3 concentration related to the degree of hyperthyroidism severity.

[Case report of a B-cell lymphoblastic lymphoma with massive mediastinal involvement]. / Przypadek chloniaka limfoblastycznego z komórek B z masywnym zajeciem sródpiersia.

A case report is presented of a 29 year old female with an initial diagnosis of a middle-grade malignant lymphoma. The diagnosis was verified basing on clinical symptoms of central nervous system involvement and results of immunological analysis of sampled lymph nodes, tonsils, and spinal fluid. The result of this analysis allowed a high-grade malignant lymphoblastic lymphoma to be diagnosed enabling to start aggressive chemotherapy followed by radiotherapy. A two year complete remission was observed.