Evaluation of occupational exposure in a slide bearings factory on the basis of urine and blood sample analyses

The impact of a slide bearings factory on its workers was examined. Urine and blood samples were collected from 42 workers and six people employed in the offices in the same factory (control group). Concentrations of Al, Cu, Pb and Zn in blood and urine samples were measured twice (before and after chelation therapy) by ICP-MS technique using standard addition method. The essential differences in concentrations of elements for workers and control group were evaluated using non-parametric Mann-Whitney U-test. Significant differences between workers and control group were found for Pb in blood and Al in urine samples. The study was also undertaken to indicate correlation between blood and urine element content, workers' ages, their period of work and work section. It was also found that intravenous administration of 1 g of calcium-disodium versanate significantly increased urinary excretion of Pb and Zn, but not Al.     

The Prevalence of Cationic Trypsinogen (PRSS1) and Serine Protease Inhibitor,Kazal Type 1 (SPINK1) Gene Mutations in Polish Patients with Alcoholic and Idiopathic Chronic Pancreatitis

Background  

The main cause of chronic pancreatitis (CP) is excessive alcohol consumption. On the other hand, only 5–10% of heavy drinkers develop chronic pancreatitis. We have only limited information regarding the pathogenic mechanism by which alcohol leads to the disease. Mutations of the PRSS1 and SPINK 1 have been mostly implicated in hereditary and idiopathic CP, but their presence in other types of this disease have also been reported.     

Syncope cluster in a patient with vasovagal history

We report a case of a 55 year-old man with a history of vasovagal syncope who experienced six unexpected syncopal events over the course of two hours. Two of these occurred in the supine position during ECG monitoring, which showed a long-lasting sinus pause. Before the last syncopal episode, the ECG recording was started at the moment when the patient had the recurrence of presyncopal symptoms. Recordings showed sinus rhythm slowing for 12 s and then sinus arrest lasting for 29 s. A thorough clinical examination revealed no relevant abnormalities. The patient was treated with a permanent pacemaker implantation.     

Analysis of angiogenesis induced by local IGF-1 expression after myocardial infarction using microSPECT-CT imaging

Insulin-like growth factor-1 (IGF-1) has been found to exert favorable effects on angiogenesis in prior animal studies. This study explored the long-term effect of IGF-1 on angiogenesis using microSPECT-CT in infarcted rat hearts after delivering human IGF-1 gene by adeno-associated virus (AAV). Myocardial infarction (MI) was induced in Sprague-Dawley rats by ligation of the proximal anterior coronary artery and a total of 10¹¹ AAV-CMV-lacZ (control) or IGF-1 vectors were injected around the peri-infarct area. IGF-1 expression by AAV stably transduced heart muscle for up to 16 weeks post-MI and immunohistochemistry revealed a remarkable increase in capillary density. A ^99mTc-labeled RGD peptide (NC100692, GE Healthcare) was used to assess temporal and regional α_v integrin activation. Rats were injected with NC100692 followed by ²⁰¹Tl chloride and in vivo microSPECT-CT imaging was performed. After imaging, hearts were excised and cut for quantitative gamma-well counting (GWC). NC100692 retention was significantly increased in hypoperfused regions of both lacZ and IGF-1 rats at 4 and 16 weeks post-MI. Significantly higher activation of α_v integrin was observed in IGF-1 rats at 4 weeks after treatment compared with control group, although the activation was lower in the IGF-1 group at 16 weeks. Local IGF-1 gene delivery by AAV can render a sustained transduction and improve cardiac function post-MI. IGF-1 expression contributes to enhanced α_v integrin activation which is linked to angiogenesis. MicroSPECT-CT imaging with ^99mTc-NC100692 and quantitative GWC successfully assessed differences in α_v integrin activation between IGF-1-treated and control animals post-MI.     

Systemic and Regional Hemodynamic Effects of Gallopamil in Patients with Essential Hypertension

Systemic and regional hemodynamics were assessed in 10 patients with uncomplicated mild to moderate essential hypertension before and during gallopamil therapy. Cardiac output was measured in triplicate with indocyanine dye. Plasma volume and renal blood flow were measured radioisotopically. Immediately following the initial dose of a slow-release (SR) formulation of gallopamil, a significant fall in arterial pressure associated with a decreased total peripheral resistance and a reflex increase in heart rate and cardiac output were seen. Then, after 8–12 weeks of treatment, arterial pressure and total peripheral resistance remained reduced, but heart rate and cardiac output returned to pretreatment levels. Gallopamil also produced significant reductions in renal and splanchnic vascular resistance. Plasma volume and total blood volume did not change. Thus, gallopamil reduced arterial pressure and vascular resistances without fluid retention or prolonged reflexive changes.     

Influence of diabetes on health-related quality of life results in patients with acute coronary syndrome treated with coronary angioplasty

The objective of this study was to prospectively evaluate the impact of diabetes on HRQOL at baseline and 6-months following ACS treated by PCI and to determine which predictors: demographic, clinical, and other variables influence QOL results in physical component summary (PCS) and mental component summary (MCS) of SF-36 health survey. The 120 consecutive patients (mean age 62.5, SD ± 9.8) with acute coronary syndrome ACS including non-ST-elevation myocardial infarction NSTEMI, n = 60 and ST-elevation myocardial infarction STEMI, n = 60 were entered into the study. Each patient was prospectively interviewed at baseline (at discharge) and 6-months following ACS. We relied on previously validated questionnaire to assess the patient’s overall health perception, namely the SF-36 health survey. Generally, the whole group demonstrated the better PCS score at 6-month follow-up: 54.7 versus 55.5; P < 0.0001. With regard to PCS, an increase in life quality results was observed in both groups. However, it should be emphasize that the diabetic group demonstrated considerably lower life quality baseline. Also, the whole group demonstrated better MCS score at 6-month follow-up: 55.9 versus 56.5; P < 0.0001. The influence of diabetes, multivessel disease, hypertension, and the high triglyceride level have negative impact on life quality evaluation, whereas male patients and patients with ACS–STEMI had better quality of life results. The influence of diabetes, multivessel disease, hypertension, and the high triglyceride level have negative impact on life quality evaluation, whereas male patients and patients with ACS–STEMI had better quality of life results. The influence of diabetes, the history of myocardial infarction, and the high triglyceride level have negative impact on life quality evaluation. Patients with ACS–STEMI had better quality of life results. The influence of diabetes, the history of myocardial infarction, and the high triglyceride level have negative impact on quality of life evaluation. Male patients had better quality of life results. (1) Diabetic patients obtain worse life quality results than non-diabetic patients, both at baseline and 6-months following PCI. (2) Positive predictors of patient’s life quality are the male sex and clinical manifestation of the disease (STEMI). (3) As regards PCS, negative predictors of patient’s life quality are diabetes, multivessel disease, high triglyceride level, and arterial hypertension. (4) As regards MCS, negative predictors are diabetes, the history of myocardial infarction, and high triglyceride level.     

Ventricular arrhythmias late after myocardial infarction are related to hypomagnesemia and magnesium loss: Preliminary trial of corrective therapy

It has been well established that in acute myocardial infarction (MI) many patients display low serum magnesium (Mg). This is associated with complex ventricular arrhythmias. The question arises whether predischarge arrhythmias occurring late after MI might also be related to Mg imbalance. In 118 patients subjected to heart rhythm 24 h Hotter monitoring in the second or third week after MI, we investigated (1) the relationship between serum Mg, urinary Mg loss, and ventricular arrhythmias, and (2) the effect of Mg supplementation on heart rhythm disturbances. In patients with undisturbed rhythm or monomorphic ventricular ectopic beats (VEB) (Lown 0-2; n = 84), mean serum Mg level (mg% ± SD) was 1.83 ± 0.21, whereas in patients with multifocal VEB, pairs, or nonsustained ventricular tachycardia (VT) (Lown 3–4; n=34) serum Mg was decreased to 1.68 ± 0.27 (p < 0.01). Serum Mg normal range in our laboratory is 1.7–2.6 mg%. The lowest serum Mg reaching 1.55 ± 0.27 was found in nonsustained VT (Lown 4 b) subgroup (n = 14). Urinary Mg loss measured in 81 patients was more pronounced in those with Lown 3–4 arrhythmias (n=26) than with Lown 0–2 (n = 55). The daily values were 73 ± 22 and 54.4 ± 26 mg, respectively (p < 0.001). Thirteen patients with complex arrhythmias and low serum Mg received Mg supplementation (MgSO₄, 8 g in 500 ml 5% glucose intravenously during 24 h). This resulted in restoration of almost undisturbed rhythm in 10 subjects. In conclusion, a number of patients in late phase of MI displayed hypomagnesemia concomitant with augmented Mg excretion. These alterations were related to the occurrence of arrhythmias: die most threatening heart rhythm disturbances were accompanied by the lowest serum Mg and the highest Mg excretion. Our preliminary observations suggest that supplementation with MgSO₄ may be a reasonable approach to the treatment of predischarge complex ventricular arrhythmias after MI. This should be verified in a controlled trial.     

From obesity through immunity to type 2 diabetes mellitus

Diabetes mellitus is a metabolic disorder that leads to the development of a number of complications. The etiology of each metabolic complication is undoubtedly multifactorial. Patients with diabetes have increased susceptibility to and severity of infections. The course of infections is also more complicated in the patient group. One of the possible causes of this increased prevalence of infections is defect in immunity. Different disturbances in humoral innate immunity have been described in patients with diabetes. Concerning cellular innate immunity, most studies show decreased functions of polymorphonuclear cells and monocyte/macrophages of these patients compared to cells of healthy subjects. Several studies have shown alterations in peripheral blood mononuclear cells from patients with type 2 diabetes, an effect that contributes to the high incidence of infections in these patients. The gut microbiota plays different roles such as the following: protects against pathogens, helps in the maturation of the immune system, regulates the intestinal hormone secretion, synthesizes vitamin K and several vitamins B, and produces short-chain fatty acids (SCFAs). It also plays a role in immunomodulation and might contribute to the alterations in glucose metabolism. In the present review, I focused on the role of obesity, the immune system, and the gut microbiota in the pathogenesis of type 2 diabetes mellitus, and as a second point, how type 2 diabetes impairs the immune system.     

Progression of preexisting trigeminalgia to Tolose-Hunt-like syndrome. The importance of neuroimaging for early differential diagnosis

Abstract. Recurrent unbearable, paroxysmal, unilateral facial pain in the distribution of one or more branches of the trigeminal nerve often provoked by sensory stimuli is typical for idiopathic trigeminal neuralgia. The less frequent localization in the area of ophthalmic branch (5%) is particularly controversial and should be distinguished from pathological lesions in the brainstem and middle and posterior cranial fossa and from disesases of the orbit and eye. This case study presents a 79-year-old woman with typical clinical features of 1st division trigeminalgia without any neurological loss and with normal results of laryngological, ophthalmological, and stomatological examinations as well as neuroimaging CT, and MR /MRA evaluation. Only the evoked potential blink and masseter reflexes demosntrated the pathological values in the early phase of illness. After 1 year of pharmacological treatment no improvement was achieved and the pain became neuropathic and paresis of 3rd, 4th and 6th nerves developed, as observed in Tolose-Hunt syndrome. MRI of the orbit revealed a pathological mass in its apex with a connection to the superior orbital fissure. However, treatment with steroids was completely ineffective. Surgical resection of the tumor (leiomyosarcoma) only partially reversed oculomotor palsy and diminished aching. In differential diagnosis of idiopathic and symptomatic trigeminalgia, early MR and MRA imaging is the most essential and sometimes may be the best single test to evaluate lesions even in distant areas of the nervous system branches.     

Management of soft tissue defects in the region of finger PIP joints by means of pedicular skin flaps taken from abdomen]

Management of soft tissue defects in the region of finger PIP joints makes a serious operative problem. Commonly recommended skin plastics require a wide experience in hand surgery. There is also lack of a comprehensive doctrine of surgical therapy depending on the extent of the mutilations. The paper presents the results of treatment of 17 mutilated fingers of 11 patients (8 men, 3 females) treated over the period of 2 years (2002-2004). The method applied was pediculated skin flaps taken from an abdomen. According to the extent of lesions three groups of patients were created. Eight patients were treated as emergencies, three appeared from 4 to 11 weeks after the accident. Flaps were cut off after 20.4 days on average. The secondary plastic was performed after the following 9.5 weeks. In 2 patients tendon plastics were performed. Fingers were mobilized during the whole period of the therapy. No complications in healing of the flaps were observed. The functional results were assessed 6 months on average after the primary operation. The average TAM and TPM were evaluated as follows: group I (no, or minor tendon lesions) TAM--186 degrees, group II.