Inverse association of lipoprotein (a) with markers of insulin resistance in dyslipidemic subjects.

Lipoprotein (a) [Lp(a)] is an LDL-like particle that contains an apolipoprotein B100 molecule covalently bound to a plasminogen-like glycoprotein, apolipoprotein (a) [apo(a)]. Epidemiological evidence supports a direct and causal association between Lp(a) levels and coronary risk. On the contrary, a few prospective findings demonstrate inverse association of Lp(a) levels with risk of type 2 diabetes (T2DM). The aim of our study was to evaluate the association of Lp(a) with indicators of insulin resistance (IR) and metabolic syndrome (MS), which precede development of T2DM. We enrolled 607 asymptomatic dyslipidemic subjects (295 men and 312 women, mean age 45.6+/-14.0 years) into our cross-sectional study. Lp(a) concentrations correlated inversely with TG, AIP, insulin, HOMA, C-peptide, BMI, waist circumference, and number of MS components (p<0.01 for all). Subjects with MS had significantly lower Lp(a) concentrations in comparison with those without the presence of this phenotype (p<0.0001). Serum concentrations of Lp(a) in the lower (1(th)-3(rd)) quartiles of insulin and HOMA were significantly higher than in the 4(th) quartile of these insulin resistance markers (p<0.001). Odds ratios of having increased markers of IR (TG, HOMA) and MS in top quartile of Lp(a) also indicate inverse association of Lp(a) with IR. The results of our study support an inverse association of Lp(a) levels with IR and MS that precedes overt T2DM diagnosis.

OVARIAN GOITER AS A RARE CAUSE OF HYPERTHYROIDISM.

INTRODUCTION: Thyroid tissue ectopically located in the ovary can be reported accidentally after adnexectomy, but as a primary cause of hyperthyroidism this diagnosis is rare. The clinical search for a functional ectopic thyroid tissue requires intense clinical focus and a multidisciplinary approach. CASE DESCRIPTION: This case report demonstrates a patient with a history of Graves' disease who had undergone thyroidectomy combined with postoperative 131I radioablation. Despite the previous treatment, she developed an outburst of hyperthyroidism ten years later. Only very close follow-up enabled us to disclose the right condition. The ovarian source of thyroid hormone production was removed by laparoscopic adnexectomy and a right sided benign ovarian struma was confirmed. CONCLUSION: Most patients treated by thyroidectomy and radioiodine do not require extended periods of follow-up or postoperative investigations, but when the clinical or laboratory signs change, clinicians should be prepared to perform the necessary re-evaluation in order to provide the best care.

ULTRASOUND-GUIDED PERCUTANEOUS ETHANOL INJECTION THERAPY IN A 92 YEAR-OLD PATIENT WITH PARATHYROID ADENOMA AND WITH A HISTORY OF TOTAL THYROIDECTOMY FOR PAPILLARY THYROID CARCINOMA.

Percutaneous Ethanol Injection Therapy (PEIT) of parathyroid adenoma under ultrasound guidance is individually used as an alternative procedure in management of primary hyperparathyroidism in polymorbid elderly patients with increased surgical risk. The treatment is also suitable for patients who already underwent surgery of the thyroid gland, and any other surgery is associated with a higher risk of postsurgical complications. We present a case of a 92-year-old male patient, who underwent thyroidectomy for papillary thyroid carcinoma three years ago. Part of the regular annual follow-up visits was also ultrasonography, which showed a solitary parathyroid adenoma at the site of the removed thyroid gland. Given the underlying condition, polymorbidity and age of the patient, the PEIT method was successfully used in the therapy. The coincidence of adenoma and papillary thyroid carcinoma is also interesting.

Hypertriglyceridemic waist - a simple clinical tool to detect cardiometabolic risk: comparison with harmonized definition of metabolic syndrome.

With the increasing prevalence of obesity and especially abdominal obesity, a simple clinical tool is needed that identifies the cardiometabolic risk for cardiovascular disease and type 2 diabetes. The aim of our study was to evaluate a broad spectrum of metabolic variables and IMT in subjects with and without hypertriglyceridemic waist (HTGW) and compare it with the harmonized definition of metabolic syndrome (MS) with both a higher (MS-I) and lower waist circumference (MS-II) for Europids. We enrolled 607 asymptomatic dyslipidemic subjects (295 men and 312 women) into our cross-sectional study. The subjects with HTGW had an atherogenic lipid profile (significantly higher triglycerides, AIP, non-HDL-C, lower HDL-C and ApoA-1, and the women also higher TC and ApoB), increased markers of insulin resistance (insulin, HOMA, C-peptide, proinsulin), inflammation (hsCRP), thrombosis (fibrinogen, PAI-1), SBP and DBP, and lower adiponectin (p<0.05-0.001 for all). These risk factors were entirely similar in HTGW, MS-I and MS-II. Age-adjusted IMT was significantly higher only in the women with HTGW but this significance disappeared after further adjustment for TC, SBP, and smoking. Our results support the routine use of HTGW as a simple and inexpensive screening tool to detect subjects at increased cardiometabolic risk in clinical practice.

Non-surgical management of thyroid abscess with ultrasound-guided fine-needle application of an antibiotic followed by sclerotization with absolute alcohol.

Thyroid abscess is a relatively rare yet dramatic condition of the thyroid gland requiring immediate therapeutic intervention. Traditionally, more or less aggressive surgical approaches and administration of broad-spectrum antibiotics have been used. Clinically less severe disease allows non-surgical treatment as well. The case report describes successful treatment of a large abscess of iatrogenic origin after biopsy of a cystic cavity. A combination of broad-spectrum antibiotics was used based on culture results, administered both orally and by repeated application directly into the abscess cavity using an ultrasound-guided fine-needle approach. Concurrent repeated evacuation of the cavity replaced drainage. Ultimately, a small residual cavity with sterile contents was managed by sclerotization with absolute alcohol. Clinical condition permitting, thyroid abscess may be successfully treated by repeated application of a targeted antibiotic, using a fine needle and ultrasound guidance, directly into the abscess cavity, with repeated evacuation replacing drainage.

Soluble intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 in asymptomatic dyslipidemic subjects.

AIM: The plasma levels of soluble intercellular cell adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule-1 (s-VCAM-1) were assessed in clinically asymptomatic subjects to compare them between normolipidemic and various dyslipidemic phenotypes. The associations between soluble cell adhesion molecules (s-CAMs) and risk factors for atherosclerosis, markers of insulin resistance, and the intima-media thickness of the common carotid artery (IMT) were evaluated, too. METHODS: Thwo hundred and thirty-four asymptomatic subjects were divided into four dyslipidemic phenotypes (DLP) according to apolipoprotein B (apoB) and triglycerides (TG): DLP1 (N.=58, apoB<1.2 g/L and TG<1.5 mmol/L), DLP2 (N.=47, apoB<1.2 g/L and TG≥1.5 mmol/L), DLP3 (N.=31, apoB≥1.2 g/L and TG<1.5 mmol/L) and DLP4 (N.=98, apoB≥1.2 g/L and TG≥1.5 mmol/L). DLP1 (normo-apoB /normo-TG) served as a control group. RESULTS: A significant difference in s-ICAM-1 between DLP1 (502.0 [457.1-568.2] ng/mL) and DLP4 (567.9 [502.8-692.1] ng/mL, P<0.001) was found. No significant differences in s-VCAM-1 between DLPs were apparent. S-ICAM-1 was independently predicted by HDL-cholesterol, non-HDL-cholesterol, proinsulin, C-peptide, waist, systolic and diastolic blood pressure. S-VCAM-1 was predicted only by age and systolic blood pressure. Both s-CAMs were detected as independent predictors for IMT, which was significantly increased in DLP 4. CONCLUSION: The elevation of s-ICAM-1 was presented only in patients with simultaneously elevated TG and apoB (DLP4) in comparison with normolipidemic subjects. Patients with DLP 4 had significantly increased IMT, which was independently predicted by levels of s-ICAM-1 and of s-VCAM-1. These findings pointed out DLP4 subjects as individuals with the highest risk for early manifestation of atherosclerosis.

Significance of HLA nondependent risk factors of chronic transplant nephropathy for the development of endothelial dysfunction after kidney transplantation.

More than 40% of renal allografts show chronic transplant nephropathy (CTN) early after renal transplantation. Cardiovascular disease is the leading cause of death in this population. Thus endothelial dysfunction represents an early angiopathy causing CTN and atherosclerosis. We sought to evaluate changes in endothelial dysfunction and vascular wall thickness during the first year posttransplantation as well as their association with HLA nondependent risk factors for CTN. At 3 and 52 weeks after grafting, we studied 25 patients without overt atherosclerotic disease and acute posttransplant complications for von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), big endothelin-1 (ET-1), flow-mediated dilatation (FMD), intimal media thickness (IMT), serum total cholesterol (TC), and triglycerides (TAG). FMD and IMT at 52 weeks showed significant correlations (P < .05) with recipient age, and the FMD ratios at 3 and 52 weeks correlated with the time on hemodialysis. Recipient age was significantly correlated with TC and PAI-1 with TAG. vWF was the only parameter that significantly correlated with donor age. There were no significant correlations with creatinine clearance. Decreased TAG approached statistical significance (P = .07) and TC decreased nonsignificantly. The worsening of FMD and ET-1 was not significant. A nonsignificant improvement in IMT was not associated with any analyzed parameters. Our results implied that the time on hemodialysis, the presence of hyperlipoproteinemia, and the recipient age significantly contributed to endothelial dysfunction during the first year after transplantation.

Brachial endothelial function in subjects with familial combined hyperlipidemia and its relationships to carotid artery intima-media thickness.

AIM: The aim of this study was to quantify the flow-mediated dilatation (FMD) of brachial artery in asymptomatic members of families with familial combined hyperlipidemia (FCH) and to determine the relation between FMD and risk factors accompanying FCH. We also investigated the association between FMD and the intima-media thickness (IMT) of the common carotid artery. METHODS: Eighty-two members of 29 FCH families were divided into two groups: probands and hyperlipidemic first-degree relatives (HL) (n=47) and normolipidemic first-degree relatives (NL) (n=35). The control (C) groups, C-HL (n=20) and C-NL (n=20), consisted of sex- and age-matched healthy individuals. FMD was assessed in the brachial artery by measuring the change in brachial artery diameter in response to reactive hyperemia. RESULTS: Both hyperlipidemic subjects and their NL had significantly lower FMD (3.4+/-3% vs 6.3+/-2.8%, P<0.001, 5.2+/-2.3% vs 7.8+/-2.8%, P<0.01, respectively) compared to controls. In multivariate backward stepwise regression analysis, FMD in members of FCH families was independently associated with sex (P<0.001), age (P<0.01), C-peptide (P<0.05) and borderline with glycemia (P=0.052). FMD correlated inversely with IMT in all subjects of FCH families and in hyperlipidemic members. In multivariate backward stepwise regression analysis this relation remained independent (P<0.001, P<0.01, respectively). CONCLUSIONS: Members of FCH families showed impaired FMD, which was independently associated with markers of insulin resistance. FMD and IMT were independently associated in hyperlipidemic, but not in normolipidemic members of FCH families.

[Problems with interpretation of low levels of thyroidal hormones conditioned by changes in transport proteins]. / Problémy s interpretací nízkých hladin tyreoidálních hormonu podmínené zmenami v transportních proteinech.

In clinical practice, we often observe conditions accompanied by secondary drop of binding proteins that bind, more or less specifically, thyroidal hormones. This is usually considered as normal situation that is often not properly interpreted from clinical point of view. In other words, we tolerate such conditions because we build on values of free hormones FT3 and FT4. However, it is very rare to observe significant decrease or even absence of thyroxin binding globulin (TBG) due to inborn error of metabolism. In such situations, the overall level of thyroidal hormones becomes a part of evaluated laboratory profile. Unusual laboratory constellation is in sharp contrast to the so-called "healthy patient". Due to increased migration of persons, we had an opportunity to take care of a patient of this kind.

Detection of early atherosclerosis using the ultrasound parameter of the intima-media thickness of the common carotid artery in families with familial combined hyperlipidemia.

AIM: The aim of the present study was to quantify intima-media thickness (IMT) of the common carotid artery (CCA) in clinically asymptomatic members of familial combined hyperlipidemia (FCHL) families and to evaluate its association with lipids, apoproteins, blood pressure, surrogate markers of insulin resistance, fibrinogen and hs-CRP. METHODS: The group under study consisted of 82 individuals from 29 FCHL families (47 hyperlipidemic [HL] and 35 normolipidemic [NL]). They were compared with the age and sex adjusted control groups of healthy subjects (HL-c, n=20 and NL-c, n=20). IMT was measured by ultrasound at a far wall of both common carotid arteries. RESULTS: Hyperlipidemic subjects had increased IMT compared with healthy controls (0.695+/-0.118 vs 0.599+/-0.074 mm), with an age and sex corrected difference of 86 mm (p<0.001). No difference in IMT was recorded in NL FCHL members in comparison with their healthy controls. In HL subjects, significantly positive univariate correlations were observed between IMT and age, total cholesterol, LDL-cholesterol, non-HDL-cholesterol, apolipoprotein B, SBP, DBP, BMI, waist, fasting glycemia, C-peptide and proinsulin, whereas in NL subjects IMT correlated only with age. Multivariate regression analysis in FCHL subjects (HL+NL) revealed that age (p<0.001), sex (p<0.001), non-HDL-cholesterol (p<0.01) and BMI (p<0.05) were significant and independent predictors of IMT. CONCLUSIONS: The increase of IMT CCA in hyperlipidemic still clinically asymptomatic FCHL subjects corresponds to acceleration of the clinically ''silent'' atherosclerosis by about 8-14 years and is in agreement with their increased risk of atherosclerosis.

[Endothelial dysfunction in a family with familial combined hyperlipidemia]. / Endoteliální dysfunkce u clenu rodin s familiární kombinovanou hyperlipidémií.

Familial Combined Hyperlipidemia is the most frequent familial hyperlipidemia with a high risk a early manifestation of arteriosclerosis. Endothelial dysfunction is the first step in the development of arteriosclerosis. The aim of our investigation was to examine selected markers of endothelial dysfunction in hyperlipidemic members of families with familial combined hyperlipidemia and their normolipidemia first-line relatives and to compare them with healthy individuals. The study includes non-smoking members of the affected families (probands and first-line relatives), who have not suffered from clinical manifestations of arteriosclerosis and/or hypertension during the start of the study. The cohort was divided into hyperlipidemic individuals (N = 25) and normolipidemic individuals (N = 21). Both groups were compared with control groups of healthy individuals (two groups, N = 17 each), who were adjusted by age and sex. The following markers of endothelial dysfunction were examined: 1. ultrasound--flow mediated dilatation of brachial artery and 2. humoral--serum levels of von Willebrand factor, inhibitor of activator of plasminogen-1 and vasoadhesive molecules (vascular cell adhesion molecule-1, intercellular adhesion molecule-1). The members of families with familial combined hyperlipidemia displayed symptoms of endothelial dysfunction. In comparison with healthy controls the endothelial dysfunction was more expressed in hyperlipidemic individuals. They displayed a significantly lower flow-mediated dilatation of brachial artery (3.6 +/- 3.3% versus 6.6 +/- 2.8%, P < 0.01), higher levels of von Willebrand factor (152.8% +/- 79.1% versus 110.4% +/- 24.8%, P < 0.05), inhibitor of activator of plasminogen-1 (94.6 +/- 30.8 ng/ml versus 60.4 +/- 38.0 ng/ml, P < 0.01) and vasoadhesive molecules: vascular cell adhesion molecule-1 (927.0 +/- 167.7 ng/ml versus 814.7 +/- 171.1 ng/ml, P < 0.05), intercellular adhesion molecule-1 (601.7 +/- 89.5 ng/ml versus 544.8 +/- 59.8 ng/ml, P < 0.05). The normolipidemic individuals displayed only a significantly lower flow-mediated dilatation of brachial artery (5.6 +/- 2.6% versus 7.5 +/- 2.8%, P < 0.05) and higher levels of von Willebrand factor (136.8 +/- 40.32% versus 104.1 +/- 24.9%, P < 0.05). No significant difference was found in the levels of inhibitor of activator of plasminogen-1 and vasoadhesive molecules. The results indicated that members of families with familial combined hyperlipidemia represent a high-risk group from the standpoint of early manifestation of arteriosclerosis.

Noninvasive measurement of early atherosclerosis by high-resolution B-mode ultrasonography.

Development of sophisticated noninvasive methods permits the identification of asymptomatic subjects with early atherosclerosis. High-resolution B-mode ultrasound measurement of the intima-media thickness (IMT) is a safe and reproducible way of quantifying early changes in the arterial wall, mainly in the carotid arteries. Increased carotid IMT is associated with major cardiovascular risk factors and seems to be a powerful predictor of cardiovascular events, especially coronary artery disease.