The contributions of fasting and postprandial blood glucose increments to oxidative stress and inflammation in dyslipidemic type 2 diabetic patients with stable ischemic heart disease.

BACKGROUND/OBJECTIVES: Contributions of fasting and postprandial blood glucose increments on level of inflammation and oxidative stress biomarkers in patients with stable ischemic heart disease (IHD) and diabetes mellitus type 2 (T2DM) was evaluated. METHODOLOGY: Ninety T2DM patients (60 with IHD and 30 without IHD) treated with metformin and/or sulphonylurea were enrolled in cross-sectional nested case-control clinical study. The areas under the six-point daily glucose curve above the fasting glucose concentrations (AUCpp) and over 5.5mmol/L (AUCbg) were calculated to determine postprandial (AUCpp) and fasting (AUCbg-AUCpp) glucose increments. Malondialdehyde (MDA), protein carbonyl group (PCO), fibrinogen, C-reactive protein (hsCRP), leukocyte count and adhesion molecules ICAM-1 and VCAM-1 were determined. RESULTS: AUCbg-AUCpp 58.2 (95%CI 40.6-75.8) was higher in IHD group compared to non-IHD 36.9 (95%CI 23.5-50.2) mmol*h/L. They had significantly higher ICAM-1 (mean±SD) 72.70±30.6 vs. 60.22±22.6ng/mL and MDA 16.47±4.5 vs. 13.42±4.01µmol/g plasma proteins, but similar PCO, VCAM-1, fibrinogen, hsCRP concentration and leukocyte count. AUCpp positively correlated with MDA (r=0.45) and ICAM-1 (r=0.32) in the presence of IHD, and VCAM-1 (r=0.44) in the absence of IHD. AUCbg-AUCpp positively correlated with PCO (r=0.45) in the absence of IHD. The analysis revealed that AUCpp over turning point of 0mmol*h/L was associated with high MDA and ICAM-1 expression in diabetics with IHD. AUCbg-AUCpp over 30mmol*h/L leads to high oxidative protein modification in diabetics without IHD. CONCLUSION: In T2DM patients with stable IHD, AUCpp at any point, significantly contributes to increasing of MDA and ICAM-1 expression. Fasting blood glucose increment showed significant correlation with carbonyl content in diabetics without IHD.

Primary and salvage total laryngectomy. Influential factors, complications, and survival.

PURPOSE: In this retrospective study we analysed patients with advanced squamous cell carcinoma of the larynx and hypopharynx treated with primary total laryngectomy (PTL) between 1990 and 2007. METHODS: The patients were treated by classical PTL, radiotherapy 60-70 Gy, concomitant radio and chemotherapy (cisplatin and 5-fluorouracil) or salvage total laryngectomy (STL). They were followed up for 5 years and complications, survival, residual/recurrent disease and metastases were registered. RESULTS: STL after previous radiotherapy (STL-pRT), and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than PTL. Five-year disease-free survival (DFS) rate was significantly influenced by TNM stage and localization of the primary laryngeal tumor. For laryngeal cancer it was: 61.3% for PTL, 54.1% for STL-pC-TRT, and 47.6% for STL-pRT. Incomplete responders to initial treatment had low survival rate. PTL for hypopharyngeal carcinoma and particularly salvage laryngectomy after chemoradiotherapy were associated with more frequent local complications. The 5-year DFS for hypopharyngeal cancer was lower than for laryngeal cancer. CONCLUSION: PTL still offers the best survival rate with low complications for advanced laryngeal and hypopharyngeal squamous cell carcinoma. STL causes more frequent local complications, especially after chemoradiotherapy. Addition of chemotherapy to radiotherapy increases the survival. Five-year DFS rate depends on TNM stage and localization of the primary tumor.

Influential factors, complications and survival rate of primary and salvage total laryngectomy for advanced laryngeal cancer.

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60-70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy when compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor.

Head and neck cancer surgery in elderly: complications and survival rate.

The number of aged patients with head and neck cancer is increasing. The aim of this study was to evaluate the outcome of elderly patients with head and neck cancer undergoing surgery. Retrospective analysis of a series of 1509 consecutive patients separated in two groups regarding their age: younger than 70 and older than 70 years, with head and neck tumors treated surgically was performed. Pre-existent comorbid conditions, immediate and long-term surgical and medical complications were analyzed. Postoperative surgical and medical complications were scored according to their severity. During the ten years period the group of patients older than 70 years comprised of 356 patients, or 23.6%. Primary site tumor distribution was similar in both patients groups. Cancer stage grouping was equally distributed between older patients and the other patients. We found the biggest incidence of postoperative complications for hypopharyngeal, than laryngeal, and oropharyngeal cancer. Swallowing difficulties were documented in 16.5% for hypopharyngeal, 10.0% for laryngeal, and 7.3% for oropharyngeal site. Aspiration was present in 3.1% to 1.8%, respectively. Survival rate was similar for different cancer locations, and was more influenced by the advancement of tumor. Postoperative complications are related to tumor location, and extent of the disease. According to the results of our study head and neck cancer in elderly should be treated by conventional protocols.

Changes in auditory ossicles in rheumatoid arthritis: scanning electron microscopic study.

The aim of this study was to define the existence of surface changes on auditory ossicles caused by rheumatoid arthritis. The study comprised of nine pairs of auditory ossicles (mallei and incudes) from autopsy of patients with rheumatoid arthritis, and five pairs of ossicles from persons without RA, taken during autopsies. The specimens were studied with JEOL JSM 5300 type scanning electron microscope. Surface changes of auditory ossicles were defined, affected areas were calculated, and expressed in percentage of total surface. Changes in auditory ossicles in patients with rheumatoid arthritis are significantly higher than in control ossicles, both on ossicular surface and articulations. Increased lysis of incudes, especially in the region of long propagation, corresponds to vascular damage. Articular degeneration is also present, indicating specific rheumatoid alteration. Both changes are statistically more intense in cases with longer duration of disease. In conclusion, rheumatoid arthritis reduces vascularity of auditory ossicles and causes degeneration of articular surfaces.

Immunofluorescent study of polyps in nose and paranasal cavities.

OBJECTIVES: Aim of this research was an immunofluorescent study and to measure immunoglobulins status of the polyps in the nose and paranasal cavities. BACKGROUND: Polyps of the nose and the paranasal cavities are very often guised, and their frequency is growing with increasing chemicals and allergens. These factors interfere important research on polyps. Developments in allergology and immunology help in the detection of etiopathogenetical mechanisms of polyposis development, like the disturbance in mucus immunity. METHODS: Clinical material was collected from 100 hospitalized patients at the Department for otorinolarynology, Clinical center of Nis. All patients had transnasal ethmoidectomy and polypectomy. In 19 patients trepanation of maxillary sinus (Coldwell Luc's) was made. Materials were examined by immunofluorescense. RESULTS: IgA immunofluorescency was negative in all examined parameters when examined under a ultraviolet luminescent with immunofluorescent microscope. IgM immunofluorescency was also negative in all examined parameters while IgG immunofluorescency was positive, but with different degree of intensity. The C3b fraction complement showed positive immunofluorescency in 80% with standard intensity ++++ in all examined preparations. CONCLUSION: Study of adenoids approved disarrangement in immune elimination in all examined preparations has shown very little immunity including the "second line of defense". High percent positive C3b complement fractions, with alongside emphasis on IgG response, instigate existing humoral reaction. The epithelium is very liable to many recurrent infections, wherewith beginning end of one permanent etiopathogenetical circle IgG-C3b-mastocits-eozinophils-lgA. Profusely blocked immune-eliminations and large production of mucous can cause some nasal diseases (Tab. 2, Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

[Gender difference in hipolipemic and anti-inflammatory effects of statins in diabetics with coronary artery disease].

BACKGROUND/AIM: Statins produce hipolipemic and pleotropic effects on markers of inflammation with stabilization of atheromatous plaque. The aim of this paper was to examine gender difference in hipolipemic and antiinflammatory effects of statins in patients with diabetes mellitus (DM) type 2 with coronary artery disease (CAD). METHODS: Sixty dyslipidemic patients with DM type 2 were analyzed. Lifestyle modification and hipolipemic diet were applied in all patients divided into two groups: 30 patients with statins therapy (20 mg of simvastatin or equivalent dose of some other statins, during 3 months) and 30 patients without statins therapy. Estimation of obesity, quality of glicoregulation, and determination of inflammatory parameters: C-reactive protein (CRP), fibrinogen, total and differential leukocyte count, intracellular adhesive molecules (ICAM-1), vascular adhesive molecule-(VCAM-1) and lipid profile (total cholesterol--TC, LDL-C, HDL-C, triglicerides--TG) were done. RESULTS: Women with DM type 2 were more obese and had significant disturbances in lipid profiles, glicoregulation and inflammatory markers compared to men. Statins therapy significantly improved all lipid parameters and quality of glicoregulation in women, while there were only significant reduction of LDL-C and nonHDL-C in males. There were more significant reductions of inflammatory markers in women as compared to men with statins therapy. In the group without statins there was not such significant reduction. Concentration of ICAM-1 was the lowest in men on statins therapy, while there were no significant variability of VCAM-1 values between groups and genders. CONCLUSION: Women with DM type 2 and CAD have more prominent lipoprotein disorders and impaired glicoregulation with expression of enhanced proinflammatory state which could not be seen in men. Statins therapy exerts more favorable effects in women leading to stabilization of lipoprotein profiles, improvement of glicoregulation and reduction of inflammatory markers. More superior antiinflammatory effects of statins therapy in men were registered only in significant ICAM-1 reduction.