One-year follow-up of patients with acromegaly treated with fixed or titrated doses of lanreotide Autogel.

OBJECTIVE: Somatostatin analogue treatment is first-line medical therapy for acromegaly. This study compared the efficacy and tolerability of titrated doses of the long-acting somatostatin analogue preparation lanreotide Autogel with fixed doses and with lanreotide prolonged release (PR) 30 mg microparticles. PATIENTS: Patients entering the initial study had received a diagnosis of active acromegaly within the previous 5 years. DESIGN: This open, comparative, multicentre study was a 1-year extension of a previous trial during which patients with acromegaly had switched from lanreotide PR 30 mg microparticles injected intramuscularly every 7, 10 or 14 days, for at least 3 months, to one of three fixed doses of lanreotide Autogel (120, 90, or 60 mg every 28 days, respectively). In this extension study, patients continued to receive 60, 90, or 120 mg of lanreotide Autogel by deep subcutaneous injection every 28 days for 1 year. Doses could be titrated at entry or after four or eight injections, according to the GH/IGF-I response (dose increased if GH > 2.5 micro g/l, or decreased if GH < 1 micro g/l with normal IGF-I). MEASUREMENTS: Mean +/- SEM GH and IGF-I concentrations were analysed and gallbladder echography performed at weeks 0, 16, 32, and 48. Acromegaly symptoms were recorded monthly and tolerance and side-effects were monitored throughout the study. RESULTS: In total, 130 patients entered this extension phase. After 1 year of treatment with titrated doses of lanreotide Autogel, mean GH (2.4 +/- 0.2 micro g/l) and IGF-I (287 +/- 12 micro g/l) concentrations were significantly lower than with lanreotide microparticles (GH, 2.8 +/- 0.2 micro g/l, P < 0.001; IGF-I, 332 +/- 15 micro g/l, P < 0.01) or with fixed-dose lanreotide Autogel (GH, 3.0 +/- 0.2 micro g/l, P < 0.001; IGF-I, 310 +/- 14 micro g/l, P = 0.02). GH hypersecretion was reduced to

[The evaluation of bone mineral density and selected markers of bone turnover in patients with insulin dependent diabetes mellitus]. / Ocena gestosci mineralnej kosci i wybranych markerów przebudowy kosci u chorych na cukrzyce insulinozalezna.

The aim of study was to evaluate bone mineral density (BMD) in lumbar spine (AP Spine), total body (Total Body) and distal site of radius (Forearm), and selected markers of bone formation: serum alkaline phosphatase (ALP) and osteocalcin(OC), and bone resorption: pyridinoline (PIR) and deoxy-pyridinoline (DPIR) in urine, in patients with long-standing insulin-dependent diabetes mellitus (IDDM), in comparison to healthy controls. Additionally, the influence of age, sex, smoking, duration of IDDM, the degree of metabolic control, or coexisting chronic complications of diabetes (retinopathy, incipient nephropathy, polyneuropathy) on the studied indices of bone metabolism in patients with IDDM were evaluated. The study was carried on 54 diabetic patients (23 F, 31 M) and 25 healthy individuals (13 F, 12 M). BMD was measured by DEXA (LUNAR DPX-L System). ALP was assessed by enzymatic method, and OC by RIA (Incstar Corporation). PIR and DPIR were assessed by EIA (Metra Biosystems). It was found that patients with long-standing IDDM have significantly lower BMD than healthy controls. The incidence rate of osteopenia and osteoporosis is significantly higher in this group of patients in comparison to the controls. In comparison to healthy subjects, patients with IDDM have significantly higher, but within normal reference range, serum ALP and OC, accompanied by similar PIR and not significantly increased DPIR. Duration and metabolic control of diabetes, or the coexistence of its chronic complications do not correlate with BMD or the studied indicies of bone turnover.

[Decreased bone mineral density in patients with insulin-dependent-diabetes]. / Obnizona gestosc mineralna kosci u chorych zcukrzyca insulinozalezna

UNLABELLED: The aim of study was an evaluation of bone mineral density (BMD) measured by LUNAR DPX-L System in lumbar spine (AP), total body and distal site of forearm (Forearm) in patients with insulin-dependent diabetes mellitus (IDDM), in relation to duration of the disease, degree of metabolic control and serum osteocalcin (OC). The study was performed on 58 patients with IDDM (26 F, 32 M; mean age: 40.1 +/- 10 yrs, mean duration of IDDM: 17.2 +/- 8 yrs) and 33 healthy, age-matched subjects (18 F, 15 M). Patients with overt nephropathy, concomitant diseases known to affect bone metabolism and women after menopause were excluded from the study. BMD was decreased in patients with IDDM in comparison with the controls: 1.13 +/- 0.1 vs 1.25 +/- 0.15 g/cm2, p < 0.001 in AP, 1.12 +/- 0.07 vs 1.2 +/- 0.07 g/cm2, p < 0.001 in Total body oraz 0.37 +/- 0.05 vs 0.4 +/- 0.05 g/cm2, p < 0.05 in Forearm. The degree of metabolic control of IDDM evaluated by serum HbAlc levels did not influence the values of BMD. Similarly, duration of IDDM did not correlate with BMD. OC level was significantly higher in diabetic patients than in control group: 4.88 +/- 2.2 vs 3.89 +/- 1.2 ng/ml, p < 0.05. CONCLUSIONS: 1) In patients with long-standing IDDM, Total Body, AP Spine and Forearm BMD were significantly decreased in comparison with the controls, and the decrease of BMD was higher in men than in women. 2) In patients with IDDM the decrease of BMD did not depend on the degree of metabolic control and duration of the disease. 3) Serum OC determinations may help in the identification of cases with risk of development of diabetic osteopenia.

[Elevated plasma prekallikrein level in patients with diabetes]. / Podwyzszony poziom prekalikreiny osoczowej u chorych na cukrzyce.

The contact activation of intrinsic pathway in the coagulation system accompanied by plasma kallikrein-induced kinin generation is thought to be involved in the pathogenesis of diabetic retinopathy. Plasma prekallikrein (PPK), a proenzyme of plasma kallikrein, is a single-chain glycoprotein synthesized mainly in the liver. The aim of our study was to evaluate plasma prekallikrein level in diabetic patients and to examine the relationship between PPK and the metabolic control of diabetes and development of retinopathy. In 53 diabetic patients and 33 healthy subjects as controls the following parameters have been assessed: plasma prekallikrein, serum fructosamine, glycated haemoglobin HbA1c, prothrombin time, partial thromboplastin time and antithrombin III (AT III). Compared to the control group, PPK level was significantly higher in diabetics, especially in patients with proliferative retinopathy. The significant positive correlations have been found between PPK and HbA1c in diabetic patients and between PPK and serum fructosamine concentration but only in diabetics without retinopathy. No differences in prothrombin time and AT III have been observed between diabetics and healthy subjects. A suggestion is presented on increase of plasma prekallikrein level in diabetics due to hyperglycaemia-stimulated glycoprotein over-synthesis in the liver, what would confirm the role of kallikrein-kinin system in the pathogenesis of microangiopathy.

[Selected parameters of blood coagulation and fibrinolysis and their relationship to the level of diabetes control in patients with insulin-dependent diabetes mellitus]. / Wybrane parametry ukadu krzepniecia i fibrynolizy oraz ocena ich zaleznosci od stopnia wyrównania cukrzycy u chorych na cukrzyce insulinozalezna.

The aim of the study was to evaluate plasma concentration of fibrinogen, plasma activity of antithrombin III (AT-III) and plasma activity of plasminogen activator inhibitor (PAI-I) in insulin-dependent diabetic (IDDM) patients and the assessment of correlation between them and the parameters of glyco-metabolic control comprising glycemia and concentrations of fructosamine and glycated hemoglobin HbA1c. Eighteen IDDM patients (mean age 28.3 +/- 11.3 ys, mean duration of disease 12.2 +/- 5.3 ys) without over nephropathy and without macroangiopathy were investigated. Control group consisted of 8 healthy subjects. Plasma fibrinogen concentrations were similar in IDDM patients and in controls (3.54 +/- 0.45 g/l and 3.31 +/- 0.54 g/l respectively). Plasma activity of AT-III in diabetic patients (90.6 +/- 22.4%) was similar to that in healthy subjects (94.6 +/- 25.0%). Fibrinogen concentrations and AT-III activities showed no correlation with glycemia and concentrations of fructosamine and HbA1c. Plasma activity of PAI-I was significantly lower in diabetics than in controls (respectively 1.56 +/- 0.72 U/ml and 2.75 +/- 1.25 U/ml, p < 0.005). PAI-I activity correlated negatively with fasting blood glucose (p < 0.05) but did not correlate with concentrations of fructosamine or HbA1c. The results suggest that glycemic control in diabetic patients do not influence on concentrations of fibrinogen and activity of AT-III but diminished activity of PAI-I is related to hyperglycemia.

[Churg-Strauss syndrome: two cases histories]. / Zespól Churga-Straussa: opis dwóch przypadków.

Two cases of Churg-Strauss syndrome with severe polyneuropathy have been diagnosed according to clinical and histopathologic criteria. Perforation of small intestine, successfully treated with surgery, was observed in one of two cases. The resected part of gut presented specific histologic picture of Churg-Strauss syndrome.

[Effect of treatment of arterial hypertension on renal function in patients with imminent and overt diabetic nephropathy]. / Wplyw efektywnego leczenia nadcisnienia tetniczego na czynnosc nerek u chorych z zagrazajaca i jawna nefropatia cukrzycowa.

The effect was studied of blood pressure lowering treatment on renal failure and albuminuria (UAE) in patients with type I diabetes (IDDM) and imminent nephropathy as well as in patients with over diabetic nephropathy. The group of 24 patients with imminent nephropathy was subdivided: 1. twelve patients with borderline or overt hypertension with mean BP lowered not below 100 mmHg, and 2. twelve patients with BP within the normal limits, taking no hypotensive agents. In the other group of 12 patients with overt diabetic nephropathy hypertension was lowered below 105 mmHg and kept so for at least two years. All patients estimated their glycemia and glycosuria by themselves, ate 0.8 g protein/kg/24 h and about 100 mmol Na/24h. Under hospital conditions the following were estimated: albuminuria, glomerular filtration rate (51Cr EDTA) and effective renal blood flow (131I hippurate). The same examinations were repeated 1 year and 2 years later. The lowering of BP below 100 mmHg in patients with imminent diabetic nephropathy significantly lowered microalbuminuria without changing GFR, ERPF despite good or satisfactory compensation of diabetes. Maintaining BP below 105 mmHg for 2 years did not prevent the patients with overt nephropathy to develop progressive renal failure despite the rate of GFR deterioration and of the increase of albuminuria slowed down.

[Frequency of goiter in children and adolescents in the Szczecin region]. / Czestosc wystepowania wola u dzieci i mlodziezy regionu Szczecinskiego.

The study was carried out in 2153 children and adolescents (1066 girls and 1087 boys) aged 5-20 years. The examined group was chosen randomly, according to a simple drawing scheme. The aim of the study was to evaluate frequency, size and character of goiter in developmental age population in Szczecin's region. The goiter was found in 14% of examined population (18.4% in girls and 9.8% in boys). Frequency of goiter approximated to 37% in girls and 16% in boys during puberty spurt (between 10 and 16 year of age). Small degree of thyroid enlargement was predominant in examined population. Large goiter was present more frequent in girls than in boys. We did not find clinical symptoms of thyroid gland dysfunction in examined group. Frequency of nodular goiter was 7% of children's and adolescent's population with higher incidence in boys (9%) than in girls (6%).

[Frequency of thyroid enlargement (goiter) in residents of the Szczecin region]. / Czestosc wystepowania powiekszenia tarczycy (wola) u mieszkanców regionu szczecinskiego.

The study has been carried out on 4,565 persons (2,349 girls and women also 2,216 boys and men) aged 4-64. The examined group was chosen randomly, according to a simple drawing scheme. The aim of the study is to evaluate frequency, magnitude and character of goiter in residents in Szczecin region. The goiter has been found in 19.5% persons in examined population, so it makes possible an endemic state. In consideration of a fact that goiter appears frequently among women and there are more cases of thyroid enlargement (O-B and I degree), as well as a small number of people with disturbance thyroid function only slightly endemic character is stated. Because the frequency of modular goiter among people with goiter is 20% it doesn't express extent of endemic state.

[Effectiveness of iodine prophylaxis and frequency of thyroid enlargement (thyroid goiter) and clinical diagnosis of thyroid diseases in inhabitants of the Szczecin region after the Czernobyl accident]. / Efektywnosc profilaktyki jodowej oraz czestosc wystepowania powiekszenia tarczycy (wola) i klinicznego rozpoznania chorób tarczycy u mieszkanców regionu szczecinskiego po awarii elektrowni atomowej w Czarnobylu.

The study, supported by program MZ-XVII, was carried on 4567 inhabitants of the area of Szczecin (2350 females and 2217 males). The population was chosen randomly, according to a simple drawing scheme. All subjects were clinically examined using standardised questionnaires. In 3468 persons (including 1807 girls and women, 1661 boys and men) apart form clinical examination, the assessment of thyrotropin, thyroxine and triiodothyronine in serum and frequency of antithyroglobulin antibodies and antithyroid membrane antibodies were evaluated. The data indicate that 94% of children in Szczecin's region received the prophylactic dose of iodine, mostly between the 1st and the 5th of May 1986. Only 17% of the adults received iodine. The most common preparation was Lugol solution given in a single dose. Among all persons who received iodine, only in 5% of subjects the side effects were noted (mostly in children), including symptoms of gastrointestinal tract (vomiting, abdomen pain) and occasionally intrathyroid side effects (thyroid pains). In examined population the high frequency of thyroid enlargement, mainly in women (up to 43-44% at the age group 30-50 years) was found. The frequency of clinical diagnosis of thyroid disease was higher in women than in man (most often the diffuse goiter, rarely the nodular goiter). The frequency of thyroid enlargement and clinical diagnosis of thyroid disease was not dependent on prophylactic iodine intake. The iodine prophylaxis did not influence on thyroid hormones and TSH serum levels and on frequency of antithyroid antibodies.