Henryk Witmanowski

The use of low-carbohydrate diet in type 2 diabetes - benefits and risks.

The pharmacological treatment of type 2 diabetes is increasingly being supported by the recommendation of an appropriate diet. The purpose of this study is to identify the potential benefits and risks arising from the use of one of the modern models of low-carbohydrate diet in patients with type 2 diabetes. Research shows that diet can favourably affect the health of diabetic patients. It has been shown that diet affects positively the concentration of blood glucose, glycosylated haemoglobin, and also contributes to the reduction of insulin taken in the course of drug therapy. At the same time, short-term studies have demonstrated a positive relationship of nutrition with reduction in body weight, as well as favourable changes in lipid profile of HDL cholesterol and levels of triglyceride. Attention is also drawn to the negative health effects of a low-carbohydrate diet; these include an increased risk of mineral deficiency, hypovitaminosis and reduced intake of dietary fibres. This diet may be associated with very high levels of protein which, in turn, raises the risk of renal dysfunction and the appearance of irregularities in the water and electrolyte balance. The impact of changes in the skeletal system and the development of osteopenia and osteoporosis is also observed. Besides the positive impact of this model of diet on the lipid profile parameters, its use significantly increases the risk of adverse changes in other markers predisposing to atherosclerosis occurring in individuals with type 2 diabetes. In composing a nutrition model for diabetes patients, both the benefits and potential risks of a low-carbohydrate diet should therefore take into account. At the same time, it is important to individualize the diet used, based on the current state of health, used pharmacological treatments, as well as taking into account the individual characteristics of the patient.

Supplementation with L-arginine favorably influences plasminogen activator inhibitor type 1 concentration in obese patients. A randomized, double blind trial.

Background: Elevated plasminogen activator inhibitor type 1 (PAI 1) plays an important role in the pathogenesis of excess blood coagulability in obese patients. L-arginine supplementation has shown to be associated with enhanced cardiovascular and metabolic health. The aim of the study was to assess the effect of L-arginine supplementation on PAI 1 concentration and to evaluate the relation to changes in nitric oxide (NO) plasma level, insulin sensitivity (M value), and total antioxidant status (TAS) in obese patients. Material/subjects and methods: A randomized, double-blind, placebo-controlled study was conducted from March 2010 to June 2011. Eighty-eight obese patients were randomly assigned to receive either 9 g of L-arginine or placebo daily for 6 months. At baseline and after 6 months, selected anthropometrical measurements and blood biochemical analyses were performed, and PAI 1, NO, TAS levels were assessed. Insulin sensitivity was evaluated using the hyperinsulinemic euglycemic clamp technique. Results: We found that 6-month L-arginine supplementation resulted in significant decrease of PAI 1. Significant increase of NO, TAS, and insulin sensitivity level were noticed. In a group of patients treated with L-arginine, negative correlation between a change of insulin sensitivity value and a change of PAI 1 concentration was found. Conclusions: The present findings demonstrate favorable influence of L-arginine supplementation on PAI 1 concentration in obese patients. Beneficial influence is related to insulin sensitivity improvement. The potential therapeutic role of L-arginine administration in patients with obesity needs further investigation.

Role of the internet in communication between patient and surgeon before rhinoplasty.

Abstract Our aim was to assess the use of the internet for patients considering rhinoplasty, to identify the influence of the medical information acquired, and to review favourable and adverse aspects of the acquired knowledge online. A prospective study was conducted on 106 patients listed for post-traumatic or aesthetic rhinoplasty. We surveyed 18 questions to evaluate demographic and sociological data, and the importance of the information acquired from the internet. Respondents searched online for description of operations, contact with other patients, and with the surgeon, and for preoperative and postoperative pictures. Patients who were considering aesthetic rhinoplasty were given medical information by a third party or from the internet, and those who were having post-traumatic corrections were usually referred by their general practitioner. We conclude that the internet is an important source of medical information about rhinoplasty for patients, but it does not contain enough data. It plays an essential part, particularly for those patients having the operation for aesthetic reasons, in contrast to those having post-traumatic correction. Reviewing and certifying the plastic surgical websites would validate certified services. Independent, direct contact with the doctor helps patients to obtain more accurate, personalised knowledge. In addition, surgeons should support patients by giving them a list of verified websites, which would contribute to increased doctor-patient communication.

Oral mucosal manifestations in primary and secondary Sjögren syndrome and dry mouth syndrome

Introduction One of the most important symptoms of Sjögren syndrome is xerostomia. The oral cavity deprived of saliva and its natural lubricative, protective and antibacterial properties is prone to a number of unfavourable consequences. Aim To present the most important lesions on the oral mucosa in primary and secondary Sjögren syndrome and in dry mouth syndrome. Material and methods The study group comprised 55 patients including 52 women and 3 men aged 20–72 years (average: 28.25 years). Results Basing on the accepted criteria, primary Sjögren syndrome was diagnosed in 22 (40%) patients, secondary Sjögren syndrome in 18 (32.7%) patients, and dry mouth syndrome in 15 (27.27%) patients. The physical examination and the examination of the mouth were performed and history was elicited from every patient. Conclusions The most common pathologies appearing on the oral mucosa in primary and secondary Sjögren syndrome are angular cheilitis, cheilitis, increased lip dryness as well as non-specific ulcerations, aphthae and aphthoid conditions.

Basal cell nevus syndrome (Gorlin-Goltz syndrome): genetic predisposition, clinical picture and treatment

Address for correspondence: Prof. Henryk Witmanowski MD, PhD, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical College, Nicolaus Copernicus University, 9-11 M. Skłodowska-Curie St, 85-094 Bydgoszcz, phone: +48 52 585 4017, email: hewit7@wp.pl Received: 21.06.2016, accepted: 2.08.2016. Basal cell nevus syndrome (Gorlin-Goltz syndrome): genetic predisposition, clinical picture and treatment

Autologous fat transfer to the subcutaneous tissue in the context of breast reconstructive procedures

Autologous fat transfer (AFT) is an appropriate technique for aesthetic rejuvenation of the face, aesthetic enhancement of hands, correction of the facial appearance in various disorders and constitutes a surgical alternative of treatment of numerous breast deformities ranging from distorting posttraumatic scars, post-eczema lesions, post-burn deformities to partial or total breast reconstruction. Our work is aimed to familiarize dermatologists with the technique of harvesting and implanting the aspirate of adipose cells in patients consulted for deformities of the breast. In addition, the review summarizes the most common applications of AFT in the breast reconstructive procedures. In summary, AFT is an oncologically safe, relatively complication-free, minimally invasive surgical technique, which can be used to correct a wide range of deformities, which are commonly seen by dermatologists, in the area of the face, trunk and extremities. The procedure can correct a wide range of breast deformities, from contour or single quadrant deformities up to the state after mastectomy.

Hereditary haemorrhagic telangiectasia in a patient taking anticoagulant drugs who has sustained facial trauma.

The authors present the case of a 41-year-old patient with hereditary hemorrhagic telangiectasia (HHT), who in the past had an aortic valve replacement surgery, currently takes anticoagulant drugs and has sustained an extensive trauma to the nose as a result of a dog bite. The HHT is diagnosed basing on the presence of at least three out of four symptoms or signs: spontaneous epistaxis, vascular lesions in the internal organs, skin telangiectasias and a family history of the disease. The presented patient showed hepatic angioma, history of recurrent bleeding from the tongue and spontaneous epistaxis as well as numerous skin telangiectasias. In his case, HHT coincided with chronic treatment with coagulants implemented after an implantation of the artificial aortic replacement valve, what substantially modified the clinical picture and course of treatment.

Assessment of the usefulness of three-dimensional scanner in aesthetic evaluation of post-traumatic rhinoplasty.

Abstract Preoperative, accurate measurement of spatial parameters of the external nose could be essential in the postoperative assessment of rhinoplasty. The aim of the study was to analyse the relevance of three-dimensional (3D) imaging in aesthetic evaluation after operation, to provide a standardised algorithm of nasal shape measurements, which will enable the development of software for assessing the nose before and after rhinoplasty, to perform analysis of spatial changes of both its shape and asymmetry by the new protocol of measurements. Fifty-four patients were examined preoperatively and 6 months postoperatively. The following nasal parameters were determined: rates of proportion, angles, and spatial parameters. After the operation, statistically significant differences were observed in all parameters. In conclusion, a 3D scanner can be used as a tool to assess the results of rhinoplasty. This protocol of measurements describes spatial changes of the nose shape resulting from the operation.

The development of squamous cell carcinoma in a patient after kidney transplantation: a case report

In patients with organ transplantation as compared to the general population the risk of cancer is significantly increased. The most common changes are malignant tumors of the skin, constituting 30-65% of malignant tumors found in recipients. Potential risk factors for skin cancer after a transplant operation are: solar radiation, immunosuppressive therapy, genetic factors, infection with HPV and skin cancer transmission before transplantation. In contrast to the immunocompetent population, skin cancers in transplant recipients are dominated by squamous cell carcinoma, followed by basal cell carcinoma. Squamous cell carcinoma in patients after transplantation is characterized by a strong tendency to give local recurrences and distant metastases. Due to the high risk of developing skin cancer in transplant recipients, preventive oncology plays an important role in the long-term care of patients after transplantation. This includes: sun protection, education, and early treatment of patients with precancerous lesions. It is also stressed that systematic dermatologic studies need to be carried out in patients after transplantation surgery. The paper contains basic information about skin cancers in organ transplant recipients: epidemiology, potential risk factors, treatment and prognosis. The paper presents also a case of patient who developed squamous cell carcinoma of the skin 3 years after renal transplantation.

Acne inversa goes an extra mile than hidradenitis suppurativa.

Acne inversa (AI, hidradenitis suppurativa, Velpeau’s disease, Verneuil’s disease) is a severe, chronic inflammatory dermatosis of unknown etiology, detected on the basis of clinical symptoms more frequently in women than in men. Purulent lesions in the form of nodules and inflammatory tumors, fistulas and scars are present in the areas with hair follicles and apocrine glands, most commonly on the armpits, groin, around the anus and pubic region. Acne inversa can lead to physical and mental disorders. Unfortunately, it is often misdiagnosed and ineffectively treated. The paper presents a case of a 46-year-old patient who was successfully treated surgically for AI around the anus and buttocks by excision of the changes and closure of the wound with local flaps and split-thickness skin grafts, taken with dermatome from the rear surface of the thighs. Surgical treatment is the method of choice in the treatment of severe AI.