Association between polycystic ovary syndrome and the risk of subclinical vascular disease in normal­weight women with type 1 diabetes.

INTRODUCTION    The prevalence of polycystic ovary syndrome (PCOS) among women with type 1 diabetes (T1DM) is higher than in the general population. Both diseases are associated with higher risk of premature atherosclerosis. OBJECTIVES    The aim of our study was to evaluate whether the cardiovascular risks conferred by T1DM and PCOS are additive. PATIENTS AND METHODS   The study group included 78 women divided into 4 groups: 19 women with PCOS and T1DM (T1DM+PCOS), 16 women with T1DM only (T1DM/no­PCOS), 27 women with PCOS only(PCOS), and 16 healthy women (control group). We evaluated the serum concentrations of cardiovascular disease biomarkers: soluble intercellular adhesion molecule 1 (sICAM­1) and soluble endothelial­leukocyte adhesion molecule 1 (sE­selectin). We also assessed brachial artery flow­mediated dilation (FMD) and estimated the intima-media thickness of the common carotid artery (CIMT) by ultrasonography. RESULTS    The serum concentrations of sICAM­1and sE­selectin were higher in the T1DM+PCOS group compared with women with PCOS only (P = 0.041 and P = 0.002, respectively) and were comparable to those in the T1DM/no­PCOS group. FMD and CIMT did not differ between the groups. In women with T1DM, sICAM­1 positively correlated with body mass index (r = 0.34, P = 0.047), CIMT with daily insulin dose (r = 0.37, P = 0.039), and FMD negatively correlated with diabetes duration (r = -0.42, P = 0.02). In a multivariable logistic regression model, the presence of T1DM, with adjustment for sICAM­1, was the only predictor of sE­selectin concentrations in the whole study group (odds ratio, 8.03; 95% confidence interval, 2.56-13.49; P = 0.005). CONCLUSIONS    The presence of PCOS does not increase the risk of subclinical vascular disease in young lean women with T1DM.

Impact of Real-Time Continuous Glucose Monitoring Use on Glucose Variability and Endothelial Function in Adolescents with Type 1 Diabetes: New Technology--New Possibility to Decrease Cardiovascular Risk?

Children with type 1 diabetes (T1DM) are the high-risk group of accelerated atherosclerosis. Real-time continuous glucose monitoring (RT-CGM) provides possibilities for the detection of glycaemic variability, newly recognized cardiovascular risk factor. The aim of the study was to assess the usefulness of RT-CGM as an educational tool to find and reduce glycaemic variability in order to improve endothelial function in T1DM adolescents. Forty patients aged 14.6 years were recruited. The study was based on one-month CGM sensors use. Parameters of glycaemic variability were analyzed during first and last sensor use, together with brachial artery flow-mediated dilatation (FMD) to assess endothelial function. In the whole group, FMD improvement was found (10.9% to 16.6%, p < 0.005), together with decrease in all studied glycaemic variability parameters. In patients with HbA1c improvement compared to the group without HbA1c improvement, we found greater increase of FMD (12% to 19%, p < 0.005 versus 8.2% to 11.3%, p = 0.080) and greater improvement of glucose variability. RT-CGM can be considered as an additional tool that offers T1DM adolescents the quick reaction to decrease glycaemic variability in short time observation. Whether such approach might influence improvement in endothelial function and reduction of the risk of future cardiovascular disease remains to be elucidated.

Insulin therapy with personal insulin pumps and early angiopathy in children with type 1 diabetes mellitus.

OBJECTIVE: Assessment of the effect of a treatment method change from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) on the development of early angiopathy in children with T1DM with or without retinopathy. METHODS: The study pump group involved 32 diabetic children aged 14.8, with the initial HbA1c level of 8.3%, previously treated by MDI. The patients were examined before pump insertion and after 3 and 6 months of CSII. We assessed HbA1c level, carotid artery intima-media thickness (c-IMT), and flow-mediated dilatation (FMD) of the brachial artery. The pump group was compared to a group of eight teenagers with diagnosed nonproliferative retinopathy, treated with MDI. RESULTS: HbA1c in the entire group was found to improve in the second and in the third examination. During 6 months of CSII, FMD increased and IMT decreased. Retinopathic adolescents had significantly thicker IMT and lower FMD compared to baseline results of the pump group. Treatment intensification in the retinopathy-free children enhanced these differences. CONCLUSIONS: CSII is associated with lower IMT and higher FMD. Whether on the long-run CSII is superior to MDI to delay the occurrence of diabetes late complications remains to be explained.

Relationship between endothelial dysfunction, carotid artery intima media thickness and circulating markers of vascular inflammation in obese hypertensive children and adolescents.

BACKGROUND: Adhesion molecules released by dysfunctional endothelium are considered as markers of vascular inflammation in early atherosclerosis. Non-invasive ultrasound methods are now available to detect first preclinical signs of the disease. AIM: To investigate the relationship between selected adhesion molecules and ultrasound indicators of early atherosclerosis: endothelial function measured by flow-mediated dilatation (FMD) and intima media thickness (IMT). PATIENTS: The study group consisted of 85 children, mean age 14.6 years, of whom 22 were obese, 31 were hypertensive, and 32 obese and hypertensive. The control group included 26 healthy children. METHODS: Adhesin concentrations were determined by ELISA. FMD and IMT were evaluated by ultrasound. RESULTS: A positive correlation was found between sICAM-1 (soluble intercellular adhesion molecule 1) and IMT (r = 0.32, p = 0.013, 95% CI: 0.11 to 0.49) and a negative correlation between IMT and FMD (r = -0.26, p = 0.04, 95% CI: -0.43 to -0.04) in the whole study group. In the particular groups, we found significant correlations only in obese hypertensive children. sICAM-1 correlated positively with IMT (r = 0.52, p = 0.001, 95% CI: 0.2 to 0.72) and negatively with FMD (r = -0.31, p = 0.027, 95% CI: -0.6 to -0.2). sE-selectin correlated positively with IMT (r = 0.41, p = 0.012). In regression models, IMT correlated with sICAM-1 (beta = 0.37, p = 0.03) and body mass index (beta = 0.55, p = 0.02), and FMD correlated negatively with sICAM-1 (beta = -0.47, p = 0.04). CONCLUSIONS: The association between inflammatory markers of the endothelium with impaired vasodilatation activity and the first atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of obesity and hypertension predisposes these young patients to closely related disturbances connected with early atherosclerosis.

[Interrelationship between endothelial dysfunction, IMT of the carotid arteries and adhesion molecules in obese hypertensive children and adolescents]. / Dysfunkcja sródblonka, grubosc kompleksu IMT tetnic szyjnych wspólnych i czasteczki adhezyjne u dzieci i mlodziezy z otyloscia i nadcisnieniem - analiza wzajemnych korelacji.

INTRODUCTION: Adhesion molecules released by dysfunctional endothelial cells are markers of an early atherosclerotic process. Ultrasonography of the brachial arteries (flow mediated dilatation - FMD) is used to detect an impairment of endothelial vasodilation, whereas the examination of intima-media thickness complex (IMT) of the common carotid arteries detects the earliest structural changes of the vessels. The aim of the study was to define the correlations between biochemical markers of endothelial dysfunction (sICAM-1, sVCAM-1, sE-selectin), vasodilatatory function (FMD) and early atherosclerotic changes (IMT) in children and adolescents with obesity and hypertension. MATERIAL AND METHODS: The study group consisted of 85 patients aged 14,6+/-2,4; of whom 22 obese children, 31 hypertensive children and 32 obese hypertensive children were distinguished. The control group included 26 healthy children. Adhesins concentrations were determined by an immunoenzymatic method (R&D Systems). FMD was assessed via the measurement of flow-mediated dilation of the brachial artery by ultrasound (Hewlett Packard Sonos 1000) according to the method worked out by Celermajer, whereas IMT was evaluated by means of Pignolie's method. RESULTS: Linear correlation analysis proved a significant positive correlation between sICAM-1 and IMT (r=0,32, p=0,013) and a marked negative correlation between IMT and FMD (r=-0,26; p=0,04) in the whole study group. Analysis carried out in particular groups showed significant correlations only in the group of obese hypertensive children. sICAM-1 concentration correlated markedly positively with IMT (r=0,52; p=0,001) and negatively with FMD (r=-0,37; p=0,027). sE-selectin concentration correlated significantly positively with IMT (r=0,41; p=0,012). In regression models, IMT correlated with sICAM-1 (p=0,03) and BMI (p=0,02), whereas FMD correlated negatively with sICAM-1 (p=0,04). CONCLUSIONS: The association between adhesion molecules (sICAM-1, sE-selectin) with impaired vasodilation activity and the early atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of both risk factors may predispose these young patients to closely related disturbances connected with early atherosclerosis.

[Ultrasonographic evaluation of selected parameters of the endothelial function in brachial arteries and IMT measurements in carotid arteries in children with diabetes type 1 using personal insulin pumps--preliminary report]. / Ultrasonograficzna ocena wplywu zastosowania osobistych pomp insulinowych na stopien zaawansowania procesu miazdzycowego w tetnicach szyjnych wspólnych i ramiennych u dzieci z cukrzyca typu 1--doniesienie wstepne.

INTRODUCTION: Type 1 diabetes is a known risk factor for arterial atherosclerosis. The first symptoms can be found even in childhood. The ultrasonographic measurements of intimal plus medial thickness in carotid arteries (IMT) and flow mediated dilatation (FMD) evaluated in brachial arteries, play a known role in the detection in these cases. The diabetes treatment intensification is an important factor in delaying early atherosclerotic changes. Currently, intensive treatment of children's diabetes with use of continuous subcutaneous insulin infusion with personal insulin pumps is gaining more and more popularity. THE AIM OF THIS STUDY was the evaluation of IMT and FMD indexes in children suffering from type 1 diabetes in the context of treatment intensification (multidose insulin injections v. personal insulin pumps). MATERIAL AND METHODS: We examined 64 children (29 boys and 35 girls) in the mean age 15.5 years treated with the multidose insulin injections method and 10 children using personal insulin pumps (4 girls and 6 boys) in the mean age 14.5 years. Using high resolution ultrasonography we evaluated IMT values in carotid arteries and FMD parameters in brachial arteries. In our analysis we estimated the blood concentration of lipid parameters, values of systolic and diastolic blood pressure, the age of diabetes onset, duration time of the illness and the values of HbA1c as a marker of metabolic control. RESULTS: We noticed significantly higher FMD values in patients treated with personal insulin pumps (13.7 vs. 5.5%, p=0.001). IMT values were similar in both groups (0.52 vs. 0.5 mm, p=0. 41). The level of HDL cholesterol was higher and triglycerides lower in the group with treatment intensification. The metabolic control was the same in both groups. In patients treated by the multidose insulin injections IMT correlated with systolic blood pressure values. We didn't notice any correlation between IMT and FMD in any group. CONCLUSIONS: 1. Treatment intensification (personal insulin pumps) influences better vascular endothelial function in type 1 diabetic children and seems to be a significant tool in delaying the atherosclerotic process. 2. We need more examinations to explain the role of treatment intensification in common carotid arteries wall morphology in type 1 diabetic children. 3. The ultrasonographic detection of atherosclerotic changes in arterial vessels can help in the evaluation of the changes due to different methods of diabetes treatment.

[Correlation analysis between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes -- preliminary report]. / Zwiazek miedzy rozwojem retinopatii cukrzycowej a wystepowaniem wczesnych zmian miazdzycowych u mlodziezy z cukrzyca typu 1 -- doniesienie wstepne.

OBJECTIVE: Recent studies have shown a correlation between advanced diabetic retinopathy and late stages of atherosclerosis. There are no findings on a possible relation between diabetic retinopathy and diseases of the cardiovascular system at their earliest stage in young people with diabetes type 1. The purpose of the study was to analyze a correlation between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study included 28 adolescents aged 17.6+/-1.4 years suffering from type 1 diabetes mellitus for 7.9+/-3.1 years, the mean age of the disease onset - 9.5+/-3.7 years, a mean level of HbA1c - 8.6+/-1.9%. Eight patients with developing simple retinopathy, were separated from the whole group of young people. First control group consisted of the remaining patients with type 1 diabetes chosen with regard to age and sex, without disease complications. Second control group consisted of 11 healthy young people. The function of endothelium by measuring the brachial artery dilatation -- FMD and the intima-media complex thickness of the common carotid arteries were evaluated ultrasonographically. RESULTS: Young people with retinopathy had higher systolic pressure: 133+/-19 mmHg in comparison with patients without complications: 117+/-14 mmHg (p<0.05) and healthy people: 115+/-8 mmHg (p<0.05). All patients with diabetes showed significantly lower FMD (7.6+/-5.1%, p<0.05). In the group with retinopathy, FMD equaled 7.8+/-4.1% (p=0.04) and in the group without retinopathy - 7.6+/-5.5% (p<0.05) in comparison with 12.1+/-5.1% in healthy volunteers. Significantly higher IMT was found in all patients with diabetes in comparison with healthy young people: 0.49+/-0.06 vs. 0.42+/-0.03 mm (p<0.001). Patients with retinopathy had a significantly higher value of IMT in comparison not only with controls but also with patients without complications: 0.56+/-0.06 vs. 0.47+/-0.03 mm (p<0.001). CONCLUSIONS: 1. Young people with type 1 diabetes had a significantly impaired function of endothelium and higher IMT in comparison with healthy young people. 2. Adolescents with retinopathy were characterized by significantly higher values of systolic arterial blood pressure when compared to patients without complications 3. Higher IMT was found in patients with diabetic retinopathy in comparison with patients without complications, which may suggest that macrovascular changes are more advanced in case of complications than in patients without retinopathy.

[Correlation analysis between biochemical and biophysical markers of endothelium damage in children with diabetes type 1]. / Ocena korelacji miedzy biochemicznymi i biofizycznymi markerami uszkodzenia sródblonka u dzieci z cukrzyca typu 1.

UNLABELLED: Endothelial damage is one of the earliest stages in the atherosclerosis process. Adhesion molecules, secreted from dysfunctional endothelial cells are considered as early markers of atherosclerotic disease. Ultrasonographic evaluation of brachial arteries serves to detect biophysical changes in endothelial function, and evaluation of carotid arteries intima-media thickness allows to evaluate the earliest structural changes in the vessels. The aim of the study was to the evaluate levels of selected adhesion molecules (sICAM-1, sVCAM-1, sE-selectin, sP-selectin) and endothelial function with use of brachial artery dilatation study (flow mediated dilation--FMD, nitroglycerine mediated dilation--NTGMD) and IMT in carotid arteries in children and adolescents with diabetes type 1, as well as the correlation analysis between biochemical and biophysical markers of endothelial dysfunction. MATERIAL AND METHODS: We studied 76 children and adolescents, with mean age--15.6+/-2.5 years, suffering from diabetes mean 7.8+/-2.8 years, mean HbA1c--8.4+/-1.5%. Control group consisted of 33 healthy children age and gender matched. Adhesion molecules levels were estimated with the use of immunoenzymatic methods (R&D Systems). Endothelial function was evaluated by study of brachial arteries dilation--FMD, NTGMD, with ultrasonographic evaluation (Hewlett Packard Sonos 4500) after Celermajer method, and IMT after Pignoli method. RESULTS: In the study group we found elevated levels of sICAM-1: 309.54+/-64 vs. 277.85+/-52 ng/ml in the control group (p<00.05) and elevated level of sE-selectin: 87.81+/-35 vs. 66.21+/-22 ng/ml (p<00.05). We found significantly impaired FMD in brachial arteries in the study group--7.51+/-4.52 vs. 12.61+/-4.65% (p<00.05) and significantly higher IMT value: 0.51+/-0.07 vs. 0.42+/-0.05 mm (p<00.001). Correlation analysis revealed a significant negative correlation between sE-selectin and FMD - r=-0.33 (p=0.004), and a positive correlation between E-selectin and IMT: r=0.32 (p=0.005). CONCLUSIONS: 1. In children and adolescents with diabetes type 1 we found elevated levels of adhesion molecules sICAM-1 and sE-selectin, what can confirm an endothelial dysfunction in these patients. 2. Significant negative correlation between sE-selectin level and FMD, and positive correlation between sE-selectin and IMT were found. 3. Biophysical proof of this damage is impaired brachial artery dilatation--FMD, and increased IMT values provide information about structural changes in the vessels.

[Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in children with growth hormone deficiency before GH replacement therapy]. / Ocena zaawansowania procesu miazdzycowego za pomoca badania ultrasonograficznego tetnic szyjnych wspólnych i ramiennych u dzieci z niedoborem hormonu wzrostu przed wdrozeniem leczenia substytucyjnego.

BACKGROUND: According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels non-invasively. We want to know more about pathogenetic mechanisms and about changes in vessels especially in the group of young people with risk factors of premature atherosclerosis. The role of endothelial dysfunction in the very early phase of this process is known very well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are a very good field for this kind of examinations. OBJECTIVES: Evaluation with high resolution echocardiography, selected parameters of endothelial function in children with growth hormone deficiency before replacement therapy. We measured the intimal plus medial thickness in carotid communis arteries (IMT) also. MATERIAL AND METHODS: We examined a group of 24 children (19 boys and 5 girls) aged 8-16 yr (mean 12 yr) suffered from growth hormone (GH) deficiency. The control group consisted of 24 children in similar age and sex relation. Using high resolution echocardiography, B-mode images, we measured in end diastole, distance "m-m" in brachial arteries (distance between two "m" lines which are borders among media and adventitia of near and far wall of the artery) at rest, during reactive hyperaemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technique we evaluated baseline flow and calculated degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated concentrations of cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides. RESULTS: In children with growth hormone deficiency the vessel size was smaller then in the control group and FMD was significantly impaired (10.05% v. 14.62%; p=0.058). NTGMD was similar to the control group (p=0.,371). We noticed higher IMT values in the whole examined group compared to the control group (0.52 mm v. 0.41 mm; p=0.0000). We noticed an important correlation between FMD and IMT in whole patients (examined plus control group) (p=0.004). The level of total cholesterol was higher in the examined group (p=0.039). CONCLUSIONS: 1. FMD evaluated in brachial artery, seems to be an useful sign of impaired endothelial function in children suffering from the risk factors of atherosclerosis. 2. The evaluation of IMT in carotid arteries in patients with growth hormone deficiency showed a more advanced degree of atherosclerotic changes in this group compared to healthy controls. 3. Ultrasonographic evaluation of premature atherosclerosis in children with growth hormone deficiency is a basis for the future estimation of positive effects of the replacement therapy.

[Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in obese and hypertensive children]. / Ocena zaawansowania procesu miazdzycowego u dzieci z otyloscia i nadcisnieniem za pomoca badania ultrasonograficznego tetnic szyjnych wspólnych i ramiennych.

UNLABELLED: According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels noninvasively. We want to know more about pathogenetic mechanisms and about changes in vessels especially in the group of young people with risk factors of premature atherosclerosis. The role of endothelial dysfunction in the very early phase of this process is known well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are a very good field for this kind of examinations. The aim of this study was the evaluation with high resolution echocardiography, selected parameters of endothelial function in obese and hypertensive children and adolescents. We measured the intimal plus medial thickness in carotid common arteries (IMT) also. MATERIAL AND METHODS: We examined a group of 54 children (33 boys and 21 girls) aged 13-15 yr (mean 14 yr 6 months) obese or/ and with arterial hypertension. We eliminated persons with secondary reasons for these risk factors. For better analizes we devided a whole group into 3 subgroups: patients with isolated arterial hypertension (n-20), with isolated obesity (n-15) and with cumulation of both factors together (n-19). The control group consisted of 17 children (11 boys, 6 girls) in similar age. Using high resolution echocadiography, B-mode images, we measured during end diastole, distance "m-m" in brachial arteries (distance between two "m" lines which borde with media and adventitia of near and far wall of the artery) at rest, during reactive hyperemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual administration glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technic we evaluated baseline flow and calculated degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated concentrations of cholesterol, HDL-cholesterol, LDL-cholesterol and triglicerides. RESULTS: In the whole examined group, the vessel size was larger and FMD was significantly impaired. In the group with an isolated hypertension and isolated obesity we noticed some differences but they did not achieve statistical significance. In the group with cumulation of risk factors, the "m-m" value, was significantly higher at rest, during reactive hyperemia and after medication and FMD was significantly lower. NTGMD in all subgroups was similiar to control group. We noticed higher IMT values in the whole examined group and in the subgroups compared to the control group. The highest IMT were in the case of the cumulation of hypertension and obesity. The level of triglicerides was higher in the group of isolated obesity, with obesity and hypertension and in whole examined group against control. CONCLUSIONS: 1. FMD evaluated in brachial artery, seems to be usefull in diagnosis of impaired endothelial function in young people suffering from the risks factors of athersclerosis. 2. Isolated obesity or arterial hypertension did not influence significantly on the impairing of endothelial function. 3. The degree of impairment in endothelial function is dependent on accumulation of athersclerosis risk factors (obesity and hypertension). 4. The evaluation of IMT in carotid arteries in children with obesity and hypertension, showed more advanced degree of atherosclerotic changes in this group compared to healthy controls.

Cardiac mass and function, carotid artery intima media thickness, homocysteine and lipoprotein levels in children and adolescents with growth hormone deficiency.

INTRODUCTION: Early atheromatic changes have been found in the carotid and the femoral arteries of young adults with growth hormone (GH) deficiency (GHD). It has been shown that adults with GHD have increased cardiovascular risk factors. The aim of this study was to compare atherosclerotic risk factors in children with GHD and a normal population. PATIENTS AND METHODS: Twenty-five patients (10 girls, 15 boys) with GHD qualified for GH replacement treatment were included in the study. The control group consisted of 22 healthy children (11 girls, 11 boys) with no family history of atherosclerosis and cardiovascular disease. Cardiac mass and function was evaluated by one-dimensional, two-dimensional echocardiography and the Doppler method. Common carotid intima-media thickness was measured with a linear probe (7.5 MHz). Lipid metabolism parameters (total cholesterol, HDL- and LDL-cholesterol, triglycerides), lipoprotein A (Lp(a)) and homocysteine levels were measured. RESULTS: Cardiac dimensions and systolic parameters were within normal values in both groups. The mean index of left ventricular mass (68.37 +/- 18.64 g/m2) in patients with GHD did not differ significantly compared to controls (68.48 +/- 15.56 g/m2). No significant differences between the study and control group were observed when comparing systolic and ejection fraction values. Significantly higher mean values of IVRT parameter were found (70.8 +/- 14.2 ms vs 64.09 +/- 8.54% ms; p < 0.05). Other parameters characterizing systolic function were not significantly different. The mean concentration of total (178.28 +/- 31.1 mg/dl) and LDL-cholesterol (106 +/- 28.68 mg/dl) was significantly higher in patients with GHD than in controls (157.59 +/- 22.39 mg/dl, 84.54 +/- 22.01 mg/dl; p <0.05). Lp(a) (40.34 +/- 12.45 mg/dl vs 11.02 +/- 4.82 mg/dl; p <0.05) and apolipoprotein B (ApoB) (71.12 +/- 18 mg/dl vs 56.72 +/- 11.46 mg/dl; p < 0.05) were significantly higher in patients with GHD. Carotid artery intima-media thickness (IMT) values were significantly higher in patients with GHD compared to healthy children (IMT-L 0.53 +/- 0.058 mm vs 0.41 +/- 0.045 mm; IMT-R 0.54 +/- 0.048 vs 0.42 +/- 0.42 mm, respectively). CONCLUSIONS: No significant differences in parameters of cardiac systolic function and left ventricular mass were found between patients with GHD and healthy children. However, significantly higher Isovolumetric relaxation time (IVRT) values in the group of patients may suggest impaired diastolic function. Significantly elevated IMT values in the common carotid artery were observed in patients with GHD in comparison with healthy children, which may prove the onset of atheromatosis.

[Left ventricular mass and function in growth hormone deficient children and adolescents before and after one year of recombinant human growth hormone (GH) replacement therapy]. / Masa i funkcja lewej komory serca u dzieci i mlodziezy z niedoborem hormonu wzrostu przed leczeniem i po 12 miesiacach leczenia substytucyjnego hormonem wzrostu (rhGH).

UNLABELLED: A total of 25 patients (10 girls and 15 boys) aged 8.1-16.9 years (mean 13.3+/-1.8 years), height 1.15-1.61 m (mean 1.4+/-0.1 m), body area 0.84-1.47 m2 (mean 1.14+/-0.18 m2) were examined in our study. After 12-month--rhGH therapy, 23 children (9 girls and 14 boys) were re-evaluated. Twenty two healthy and slim children (11 girls and 11 boys) aged 6.6-16 years (mean 12,6+/-2.7 years), height 1.33-1.8 m (mean 1.58+/-0.16), body area 0.93-1.8 m2 (mean 1.38+/-0.3 m2) with a family history without atherosclerosis and cardiovascular diseases constituted controls. Mass and function of LV were evaluated by means of M-mode and 2D echocardiography and the Doppler method with simultaneous 2D picture recording. Systolic function parameters (SF and EF) were normal in each patient before therapy. LV systolic fraction (SF) equaled on average 35.4+/-4.5 % in the examined group and 36.7+/-3.9 % in controls. LV ejection fraction (EF) was on average 65.1+/-5.9 % in the examined group and 67.9+/-6.4 % in controls. The differences noted were not statistically significant. After a year-rhGH therapy, SF and EF were within a normal range in each patient. SF was on average 35.9+/-3.6% in the examined group and 36.7+/-3.9% in controls. EF was on average 65.7+/-4.6% in the examined group and 67.9+/-6.4% in controls. The differences were not statistically significant. SF and EF did not differ before and after rhGH therapy. LV mass indexed by body superficial area (LVA/BSA) equaled 68.3+/-18.6 g/m2 before therapy and did not differ significantly in comparison with controls (68.2+/-15.5 g/m2). After a year-GH therapy, LV/BSA was significantly higher when compared to LV/BSA mass before therapy (78.2+/-14.9 g/m2 vs 68.3+/-18 6 g/m2, p<0.05). After a year-GH therapy LV/BSA mass was significantly higher in comparison with LV/BSA mass before therapy (78.2+/-14.9 g/m2 vs 68.3+/-18.6 g/m2, p< 0.05). Before therapy, IVRT parameter was found significantly extended in comparison with controls (70.8+/-14.2 vs 64.1+/-8.5 ms, p<0.05). Other parameters characterising LV diastolic function were not significantly different between the groups. After a year-GH therapy, IVRT parameter was still extended in comparison with controls (72.3+/-9.2 vs 64.1+/-8.5 ms, p<0.05). No significant differences were observed with regard to IVRT before and after therapy. CONCLUSION: 1. A significant extension of isovolumetric relaxation time (IVRT) was proved in children with GH deficiency, which may suggest an impaired diastolic function of the heart left ventricle. 2. 12-month-rhGH replacement therapy causes an increase in the left ventricle mass when compared to the values before therapy, whereas isovolumetric relaxation time remains still longer. 3. Children with GH deficiency should have their circulatory system monitored to observe the dynamics of the left ventricle functional disorders.

[Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in children with type 1 diabetes]. / Ocena zaawansowania procesu miazdzycowego u dzieci z cukrzyca typu 1 za pomoca badania ultrasonograficznego tetnic szyjnych wspólnych i ramiennych.

INTRODUCTION: According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels noninvasively. We want to know more about the pathogenetic mechanisms and about changes in vessels especially in group of young people with risk factors of premature atherosclerosis. The significance of endothelial dysfunction in very early phase of this process is known very well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are very good field for this kind of examinations. THE AIM of this study was the evaluation with high resolution echocardiography of endothelial function in type 1 diabetes children and adolescents. We also measured the intimal plus medial thickness in carotid communis arteries (IMT). MATERIAL AND METHODS: We examined a group of 64 children (29 boys and 35 girls) aged 14.8-16.2 yr (mean 15.5 yr) suffering from diabetes type 1. The control group consisted of 24 children (9 boys, 15 girls) in similar age. Using high resolution echocardiography, B-mode images, we measured in the diastole phase, distance "m-m" in brachial arteries (distance between two "m" lines which are borders among media and adventitia of near and far wall of the artery) at rest, during reactive hyperaemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technic we evaluated baseline flow and calculated the degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated the concentrations of cholesterol, HDL- cholesterol, LDL-cholesterol and triglycerides. RESULTS: We noticed higher IMT values in the whole examined group compared to the control group (0.52 mm vs. 0.43 mm, p<0.05). In diabetic children the vessel size was similar to control group but FMD was significantly impaired (5.56% vs. 9.47%, p<0.05). The level of triglycerides and total cholesterol was higher in the examined group. CONCLUSIONS: 1. The evaluation of IMT in the carotid arteries in patients with type 1 diabetes showed a more advanced degree of atherosclerotic changes in this group compared to healthy controls. 2. FMD evaluated in brachial artery is a usefull tool in assessing impaired endothelial function in people suffering from the risks factors of atherosclerosis. 3. Ultrasonographic methods of evaluating atherosclerotic changes in arterial vessels should be more often used in practice as relatively easy, noninvasive and inexpensive.

[Blood pressure in neonates born from pregnancies complicated by diabetes]. / Cisnienie tetnicze u noworodków urodzonych z ciaz powiklanych cukrzyca.

INTRODUCTION: Diabetes is one of the most frequent metabolic disorders that may be influenced by and occur during pregnancy. Hypertension is frequently associated with a diabetes and, as well as diabetes, is considered to be one of the risk factors of the cardiovascular and the renal disease. Diabetes during a pregnancy may predispose fetus, and therefore neonate, to develop several metabolic abnormalities. Abnormalities observed after delivery are primarily due to disregulated glucose homeostasis and are considered as indices of pregnant glycemic status. MATERIALS AND METHODS: 44 neonates (28 boys and 16 girls) from pregnancies complicated by the diabetes (12 from pregnancy in course of insulin dependent diabetes mellitus diagnosed before the conception) were included into the study. During first day of life all newborns have blood pressure evaluated (Korotkoff's method; automated measurements using Vital Signs Dinamap Plus (Criticon Inc., USA)). After each blood pressure measurement the capillary blood glucose evaluation was performed (GlucoStix, Bayer GmbH, Germany). RESULTS: We found statistically significant differences between IDDM and GDM neonates in blood glucose concentration at 1/2 and 2 hours after delivery. In all measurements the mean results of systolic blood pressure were higher in IDDM than GDM group, however the difference did not reach significance level. When comparing mean arterial blood pressure significant difference was observed at 18 hour after birth. DISCUSSION AND CONCLUSIONS: We did not find significantly higher blood pressure in neonates born from IDDM complicated pregnancies (apart from mean arterial blood pressure in one measurement). Mean values of blood pressure in IDDM group were however higher than in GDM group. It may be a signal of improper tendency of the arterial blood pressure stabilization which may require additional studies.