[Tick spirochetosis--Lyme borreliosis]. / Kretkowica kleszczowa--Borelioza z Lyme.

Lyme boreliosis is currently the most common tick-borne infection. It may cause various clinical symptoms depending on organ localization and duration of the infection. The disease may be symptomless, subclinical or with full clinical manifestation. Usually three clinical stages may be distinguished. In stage I erythema migrans and flu-like symptoms usually develop. In stage II, connected with the infection spreading with blood and lymph, beside joint pains, neuroboreliosis appears, sometimes the disease involves other organs such as heart, eyes, testicles, joints. Stage III, chronic in its character, usually develops in patients who had previously reported joint and neurological complaints. Encephalopathy and fibromyalgia accompany joint involvement. Diagnostics of Lyme borreliosis is based on clinical evaluation and laboratory test including culture of the bacteria obtained from biopsies and serological tests. There are no established standards of the treatment--some examples of the therapy are presented in the paper. The disease if not treated has a progressive course in most causes, however in some patients it can resolve spontaneously even with no treatment.

[Hyperprolactinemia. II. Diagnosis and treatment]. / Hiperprolaktynemia. Czesc II: Rozpoznawanie, leczenie.

Implementing various diagnostic methods in the past some decades has allowed to improve knowledge on hyperprolactinemia. In the diagnostics of hyperprolactinemia, besides measuring blood levels of PRL and other hormones, there may be also helpful: stimulative tests with metoclopramide and TRH, CT scans, MRI, ophthalmological examination, etc. There tumors such as prolactinoma or other reasons leading to hyperprolactinemia. Establishing cause of hyperprolactinemia is important because of various treatment modalities available.

[The value of evaluating tumor markers: CA 15-3 and ferritin in blood serum of patients grouped as "high risk" for breast cancer]. / Wartosc kliniczna oznaczen markerów nowotworowych: CA 15-3 oraz ferrytyny w surowicy krwi chorych grupy "wysokiego ryzyka" zachorowania na raka sutka.

We studied 127 patients. 35 patients (group I) with mastopathy disease (average 44.3 years old) included 9 patients with a breast cancer family history (subgroup I A), 26 patients without a breast cancer family history (subgroup I B) and 92 patients (group II) with a breast cancer of I-IV grade (average 49.25 years old). The results of the study revealed statistically significant higher level of CA 15-3 in serum of patients with mastopathy compared to patients with a breast cancer of I grade (p < 0.05). CA 15-3 level in patients with a breast cancer of III, IV grade in serum, was considerably higher and there was significant difference comparing to the patients with a breast cancer of I, II grade (p < 0.001) and patients with mastopathy disease. There were also higher average levels of CA 15-3 in patients with mastopathy disease with a breast cancer family history (subgroup I A) compared to patients without an oncological risk (subgroup I B), however there were not significant differences. There were also higher average levels of ferritin revealed in patients with a breast cancer of III, IV grade and which shows significant difference between patients with breast cancer of I, II grade and with mastopathy patients (p < 0.001). It seems that determination of CA 15-3 and ferritin in patients of a high risk group of a breast cancer could be a useful diagnostic tool for early determination of a breast cancer.

[TSH receptor antibodies in the recurrent goiter after surgical treatment of Graves-Basedow disease]. / Przeciwciala przeciw receptorowi dla TSH w wolu nawrotowym po operacyjnym leczeniu choroby Gravesa-Basedowa.

The serious complication after surgical treatment is goitre renewai. Very important is therefore the correct diagnosis based also on laboratory investigation, enabling early detection of dysthyreosis. The aim of work was assessment of immunological states of thyroid gland of patients with goitre recurrence treated surgically because of Graves-Basedow, based on investigation of TSH receptor antibodies. The time from the surgery to the examination ranged from two to eleven years. The laboratory investigation contained determination of thyroxin, free thyroxin triiodothyronin, thyreotropin and antibodies directed against TSH receptor(TRAb). It has been found that average concentration of TRAb and frequency was significantly higher in recurrent goitre then in group without goitre renewal. The results of investigation indicates usefulness of determination of thyroid antibodies in diagnosis of recurrent goitre after surgical treatment of Graves-Basedow disease.

[Mastopathy and simple goiter--mutual relationships]. / Mastopatia a wole obojetne--wzajemne powiazania.

UNLABELLED: There have been assessed physical and ultrasonographic examination in patients with mastopathy and concentration of prolactin, thyrotropin, thyroxine in blood serum of these patients. The examination was carried out in 65 patients with mastopathy (group M), at the age ranging from 18 to 53 years, and in 30 healthy women (group K), at the age from 18 to 55 years as a reference group. The group of the patients with mastopathy and the control group were divided into three subgroups (taking into account the age and function of ovaries). There were excluded from the examined group patients whose general health state, particularly endocrinological disease, and applied drugs might condition occurrence of pathological changes in mammary glands. Particular attention was paid to exclusion from examination of patients with both primary and secondary hyperprolactinemia. Non-toxic goitre was found in 80% patients with mastopathy, and the results of palpation examination of thyroid were confirmed by thyroid ultrasonographic examination. Non-toxic goitre was significantly more often in patients with mastopathy in comparison with healthy women, and there was found significantly higher thyroid volume in these patients. The hormonal evaluation showed first of all significantly higher mean concentration of prolactin in blood serum of the patients with mastopathy than in the blood serum of healthy women in comparison with both the whole examined group and subgroups. There were not significant differences between the mean concentration of thyrotropic hormone, triiodothyronine and thyroxine in blood serum in premenopausal patients with mastopathy and mean concentration of these hormones in healthy women. Only postmenopausal patients were characterized by significantly lower mean concentration of triiodothyronine in comparison with the healthy subgroup. CONCLUSIONS: 1. In patients with mastopathy, there often coexists enlargement of thyroid gland, and prolactin may be also considered as an agent which influences genesis of a goitre. 2. It should be thus admitted that hormonal examinations with particular consideration to prolactin and thyroid hormones are appropriate management in diagnosing and treatment of patients with mastopathy.

[The role of iodine in various thyroid disorders]. / Rola jodu w róznych chorobach tarczycy.

Mechanisms regulating thyroid hormone synthesis in conditions of proper iodine supply, iodine excess and iodine deficit in subjects with normal thyroid function and in patients with various thyroid gland disorders are presented.

[Usefulness of ultrasonographic tests for localizing changes in peri-thyroid nodes in patients with malignant lymphomas]. / Przydatnosc badan ultrasonograficznych w lokalizacji zmian wezlowych polozonych okolotarczycowo u chorych z chloniakami zlosliwymi.

9 cases initially suspected of toxic nodular disease were proved to be Hodgkin disease in 8 and lymphoma in one. Sonographic exams of the neck revealed enlarged peri-thyroid nodes in all cases. Biopsy of these nodes and histopathological examinations of the nodes confirmed the diagnosis.

[Assessment of selected hormonal parameters in patients with mastopathy in postmenopausal period]. / Ocena wybranych parametrów hormonalnych u chorych z mastopatia w okresie pomenopauzalnym.

There have been assessed selected hormonal parameters in patients with mastopathy in postmenopausal period. The hormonal evaluation showed significantly higher mean concentration of prolactin in blood serum of patients with mastopathy than in the blood serum of healthy women. There was not functional hyperprolactinaemia in the patients in postmenopausal period. In the examined patients in postmenopausal age, there was revealed significantly higher mean concentration of oestradiol in blood serum, in comparison with the healthy women. There was also found significantly lower mean concentration of follicle-stimulating and luteotrophic hormones, which is probably due to enhanced inhibition of gonadotrophic hormones secretion by prolactin and oestradiol. The results of the conducted hormonal examinations suggest that prolactin is an agent, which produces mastopatial changes in women. Furthermore, it seems that genesis of mastopathy in postmenopausal period may be connected not only with disprolactinaemia but also with persistent oestrogenic activity. It should be thus admitted that hormonal examinations (with particular consideration given to prolactin) are appropriate management in diagnosis and treatment of patients with mastopathy.

[Hyperprolactinemia: I. Etiopathogenesis, clinical features]. / Hiperprolaktynemia: Czesc I. Etiopatogeneza, obraz kliniczny.

Hyperprolactinemia is a frequent endocrinological disorder, which can develop in women as well as in men. Constant or periodical increase of prolactin concentrations in serum is an evidence of functional or organic damage of the hypothalamic-pituitary axis. Hyperprolactinemia features are complex, and lead toward hypogonadotropic hypogonadism. A shortened luteal phase, infertility and anovulatory cycles are clinical features in women. In men hyperprolactinemia leads to disorder of spermatogenesis (oligospermia, azoospermia) and infertility, too.

[Evaluation of the efficacy of treatment with exogenous thyroxin in patients after thyroidectomy]. / Ocena skutecznosci leczenia egzogenna tyroksyna u chorych po tyreoidektomii.

The study was performed in 228 patients after thyroidectomy, including 101 individuals permanently treated with thyroxin and 127 ones in whom treatment with thyroxin was started on the average 5 years after surgery. Control group consisted of 35 patients after thyroidectomy, average 2 years after surgery, not treated with thyroxin. Stump volumes and serum TSH concentrations were significantly higher in the patients who began treatment a long time after surgery (mean after 5 years) when compared with the control group (mean after 2 years). It was proven that treatment with thyroxin led to significant decrease of the stump volume and to serum TSH normalisation. Treatment with thyroxin was successive in not all patients with nodular regrowth; in some of them despite using suppressive doses of thyroxin, progression of the lesions occurred, what claimed for different regrowth etiology. In spite of high serum TSH concentrations in 132 patients, only in 60 of them clinical manifestation of hyperthyroidism was observed. Treatment with thyroxin should be recognised as reasonable in prophylaxis and therapy of patients after thyroidectomy.

[The role of growth factors in the pathogenesis of recurrent goiter]. / Udzial czynników wzrostowych w patogenezie wola nawrotowego.

Growing factors influenced on proliferation of follicular cekks of thyroid and probability influence upon a rising of recurrent goitre were presented. Effect of growing factors depending on TSH, specially IGF-1, EGF, FGF and thyroid growth immunoglobulins (TGI) are analysed.

[Biochemical and endocrinological analysis of breast cyst fluid]. / Charakterystyka biochemiczno-endokrynologiczna plynu torbieli mastopatycznych.

The gross cystic disease (breast cyst < 3 mm in diameter) is common benign disease of the breast. The relations GCD with breast cancer remain the fundamental problem. Although the cysts itself only exceptionaly degenerates into cancer, the presents of macrocystic disease multiplies by 3 to 4 the risk of cancer. A lot of interesting examinations were performed on cyst fluids aspirated from patients to identify women with benign breast disease and particular risk for breast cancer. There are two groups of breast cysts: these lined by apocrine epithelium and those lined by flattened epithelium. It is generally accepted that measurement of intracystic [Na+]/[K+] is a simple way of differentiating between these two groups of cysts. Higher intracystic concentrations of same substances may provide an explanation for the higher risk of breast cancer, which has been observed in low electrolyte group. Breast cyst fluid samples were analyzed for a lot of hormones, proteins, specific growth factors, adhesion molecules, bile acids, tumor markers and their levels were compared with breast cancer risk. At the present time, the biochemical measurements in cyst fluids aren't popular to identify women likely to develop breast cancer. We should use other diagnostic methods to examine these patients.

[Ultrasonic diagnosis of cold thyroid nodules]. / Diagnostyka ultrasonograficzna zimnych guzków tarczycy.

Ultrasonographic examination was carried out in 90 patients in whom single thyroid nodule was found by palpation and scintigraphic examination. In 67 of these patients (61%) the presence of a single nodule was confirmed by ultrasonography. In the remaining 23 (38%) multiple nodules were found within the gland. Ultrasonographic examination made possible the differentiation of solid lesions from the cystoid ones in 100%. Follicular adenomas appeared in ultrasonography as mixed-type nodules with the features of degeneration characterized by the presence of the areola (the so called "halo"). The Hurtle's adenomas appeared as mixed-type nodules, hypo-echogenic and devoid of areola. The observed neoplastic lesion (carcinoma follicular) was of a cystoid type. The appearance of cystoid lesions made possible the differentiation of simple cysts from those originating from tumor decomposition. Ultrasonography may then be helpful not only for distinguishing between cystoid-type and solid type lesions but also for classifying solid nodular structures as malignant or benign.

[Usefulness of ultrasonic examination for evaluating the functional and morphologic state of the thyroid in patients with nontoxic and toxic parenchymal goiter]. / Przydatnosc badania ultrasonograficznego do oceny stanu czynnosciowego i morfologicznego gruczolu tarczowego u chorych z wolem miazszowym obojetnym i toksycznym.

Ultrasonographic examination of the thyroid was carried out in 150 patients of mean age 37 +/- 11 years, including 100 patients with nontoxic parenchymal goiter and 50 patients with toxic parenchymal goiter associated with the Graves' disease. Ultrasonograph Siemens Sonoline LM with 7.5 MHz head was used in the study. The study was aimed at the evaluation of functional and morphological state of the thyroid in patients with nontoxic and toxic parenchymal goiter. In the case of nontoxic goiter, heterogeneous (100%) and normoechogenic (100%) structure of the parenchyma was visualized by ultrasonography. In toxic parenchymal goiter (Graves' disease), on the other hand, hypoechogenic (92%) and marginally pseudo-cystoid structure of parenchyma was observed. In this group of patients, high values of thyroid hormones (100%) were associated with high level of thyroid antibodies (92%). It can be concluded that ultrasonography is an useful tool for evaluation of functional and morphological state of the thyroid in patients with nontoxic and toxic parenchymal goiter.

[Ultrasonographic pattern and levels of thyrotropin and antithyroid antibodies in patients with recurrent neutral goiter after subtotal thyroidectomy]. / Obraz ultrasonograficzny oraz poziomy tyreotropiny i przeciwcial tarczycowych u chorych z nawrotem wola obojetnego po strumektomii subtotalnej.

The study comprised 65 women (mean age 43 years) with the recurrent goiter after subtotal strumectomy. All patients were subjected to ultrasonographic examination using a sonograph Sonoline LM (Siemens) with 7.5 MHz head. The study was aimed at: 1) assessment of etiology of goiter recurrence, 2) assessment of changes in the thyroid parenchyma, 3) detection of the occurrence of heterogeneous structures, such as nodules, cysts and calcifications. It was found that goiter recurrence appeared mainly in the patients subjected to surgery because of neutral nodular goiter. The observed changes in the thyroid stump, such as heterogeneous structure of parenchyma, generalized cyst-like spaces and nodular structures mainly of mixed type or of solid, normo-echogenic or hyper-echogenic type, were associated with high levels of THS and the presence of antithyroid antibodies in blood serum. In patients with evidently high TSH levels and positive with respect to occurrence of antithyroid antibodies, the nodular structures were more numerous and of larger size. In can be concluded that ultrasonography provides a valuable noninvasive tool for the evaluation of morphological structure of the recurrent goiter.

[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.