Magdalena Stasiak

Comparison of potential protective effects of melatonin, indole-3-propionic acid, and propylthiouracil against lipid peroxidation caused by potassium bromate in the thyroid gland.

Potassium bromate (KBrO3) is a prooxidant and carcinogen, inducing thyroid tumors. Melatonin and indole‐3‐propionic acid (IPA) are effective antioxidants. Some antioxidative effects of propylothiouracil (PTU)—a thyrostatic drug—have been found. The aim of the study was to compare protective effects of melatonin, IPA, and PTU against lipid peroxidation in the thyroids, collected from rats treated with KBrO3, and in homogenates of porcine thyroids, incubated in the presence of KBrO3. Wistar rats were administered KBrO3 (110 mg/kg b.w., i.p., on the 10th day of the experiment) and/or melatonin, or IPA (0.0645 mmol/kg b.w., i.p., twice daily, for 10 days), or PTU (0.025% solution in drinking water, for 10 days). Homogenates of porcine thyroids were incubated for 30 min in the presence of KBrO3 (5 mM) plus one of the antioxidants: melatonin (0.01, 0.1, 0.5, 1.0, 5.0, 7.5 mM), or IPA (0.01, 0.1, 0.5, 1.0, 5.0, 7.5, 10.0 mM), or PTU (0.01, 0.1, 0.5, 1.0, 5.0, 7.5, 10.0 mM). The level of lipid peroxidation products (MDA + 4‐HDA) was measured spectrophotometrically in thyroid homogenates. In vivo pretreatment with either melatonin or with IPA or with PTU decreased lipid peroxidation caused by KBrO3—injections in rat thyroid gland. Under in vitro conditions, PTU (5.0, 7.5, and 10.0 mM), but neither melatonin nor IPA, reduced KBrO3‐related lipid peroxidation in the homogenates of porcine thyroids. In conclusion, melatonin and IPA may be of great value as protective agents under conditions of exposure to KBrO3.

The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer

Summary Background Esophageal cancer is the seventh-most frequent cause of cancer-related deaths and it is usually diagnosed at an inoperable stage. In palliative treatment, endoscopic and non-endoscopic methods are applied to reduce dysphagia in patients with neoplastic esophageal obstruction. Because of severe complications, non-endoscopic treatment (surgery, radiotherapy, brachytherapy and chemotherapy) is applied rarely. Within the endoscopic methods, only the use of endoprostheses yields long-term effects. The aim of this study was to evaluate the safety and efficacy of implantation of self-expandable esophageal stents in palliative treatment of dysphagia related to esophageal cancer. Material/Methods A total number of 46 patients (41 males and 5 females) were qualified to palliative implantation of coated self-expandable stent. The mean age of the patients was 67 years (from 51 to 78 years). In all patients, Evolution-type coated self-expandable stents were used. In all cases, 24 hours after the implantation, radiological examination was performed to assess the stent location. Results Severe, possibly life-threatening, complications constituted 28% of all the complications and occurred in 9% of the patients. Less severe complications occurred in 17% of the observed patients and were not life-threatening. Conclusions In patients with neoplastic esophageal stenosis, stenting with coated, self-expandable nitinol prostheses is a safe, effective and fast method of palliative dysphagia treatment.

Effectiveness comparison of endoscopic methods of non-varicose upper gastrointestinal bleeding treatment.

Introduction In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding. Material and methods Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patients general condition, as well as technical equipment and manual skills of the endoscopy staff. Results The study confirmed the effectiveness of endoscopic treatment of non-varicose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%). Conclusions In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.

Cognitive Function, APOE Gene Polymorphisms, and Thyroid Status Associations in Postmenopausal Women in Poland

Background: The objective of the study was to analyze a potential association between cognitive functions and thyroid status in postmenopausal women with different polymorphisms of the apolipoprotein E gene (APOE). Methods: The examined population included 402 postmenopausal women from south-eastern Poland. The evaluation of cognitive functions was made with the use of the diagnostic Central Nervous System-Vital Signs equipment (Polish version). Multiplex polymerase chain reactions were performed to assess APOE polymorphisms. The thyroid hormone tests were assessed by an accredited laboratory. Results and Conclusion: Lower results of cognitive functions were associated with the presence of the ε4 APOE allele in postmenopausal women. The ε4 APOE polymorphism was associated with a higher concentration of thyroid-stimulating hormone and lower concentrations of free triiodothyronine and total triiodothyronine.

Patterns of cyclin A and B1 immunostaining in papillary thyroid carcinoma

INTRODUCTION AND OBJECTIVES Cyclin A, encoded by CCNA (cyclin A) gene with locus in chromosome 4q27, and cyclin B1, encoded by CCNB1 (cyclin B1) gene with locus in chromosome 5q12, are proteins that play a key role in the passage through the restriction point in G2 phase of the cell cycle. The aim of the study was to analyse immunohistochemically the expression of cyclins A and B1 in different variants of papillary thyroid carcinoma (PTC). MATERIAL AND METHODS The immunostaining patterns of the proteins in question in the tissue of 40 resected PTC (20 cases of classic variant of PTC, 9 cases of PTC follicular variant and 11 cases of other non-classic variants of PTC) were investigated. RESULTS On analyzing cyclin A and B1 expression, positive staining in 90% cases of PTC were observed. The study revealed a significant difference in expression of cyclins A and B1 between classic and non-classic variants of PTC. The expression of both examined cyclins was weaker in the classic variant of PTC. In the group of follicular variant of PTC, the expression of cyclins was of medium intensity and in the group of other non-classic variants of PTC, the expression was clearly higher. CONCLUSIONS The results of the presented study suggest that cyclins A and B1 expression may have a characteristic pattern of immunostaining for particular variants of PTC. If the obtained results are confirmed in a larger group of patients, the diagnostic panel constructed of the antibodies against these proteins may increase the diagnostic accuracy in PTC cases.

Hyperprolactinemia diagnostics – dilemmas over optimal selection of prolactinemia time points

INTRODUCTION Laboratory discrimination of pathologic hyperprolactinemia is an important step in the diagnosis of pathology influencing overall health and fertility. A major issue is the choice of time and circumstances for obtaining a blood sample for prolactin assay that would be representative for mean daily plasma concentration of a subject. OBJECTIVES The aim of the study was a comparison of reliability of single prolactin assessment on various time-points in a day with circadian prolactinemia profile in order to find the easiest, the least expensive, and the most reliable method of hyperprolactinemia diagnosis. MATERIALS AND METHOD The study was a retrospective analysis of 138 women, hospitalized in the Department of Endocrinology and Metabolic Diseases, Polish Mother`s Memorial Hospital - Research Institute, Lodz, Poland, in whom the circadian profile of prolactin (including assays at 8.00 am, 11.00 am, 2.00 pm, 5.00 pm, 8.00 pm, 11.00 pm, 2.00 am, 5.00 am and repeatedly at 8.00 am) had been assessed. RESULTS On the basis of AUC (area under the curve) of prolactin concentrations, hyperprolactinemia was diagnosed in 34 subjects (24.6 % of the entire group). The attempts to diagnose hyperprolactinemia based on a single prolactin assay failed due to a high percentage of false negative and false positive results. Only significant hyperprolactinemia with mean prolactin concentration of about 100 µg/l or more appeared easy to diagnose. Combinations of several time points also appeared not reliable enough. CONCLUSION The nine-point daily profile of prolactinemia in any patient with clinical suspicion of hyperprolactinemia seems the best mode for estimating mean circadian prolactin concentration.

Evaluation of the effectiveness of iodine prophylaxis in Poland based on over 20 years of observations of iodine supply in school-aged children in the central region of the country

Introduction Due to the mild-to-moderate iodine deficiency in Poland, in 1997 iodine prophylaxis based on obligatory salt iodization was introduced. We attempted to evaluate the effectiveness of such prophylaxis, based on over 20 years of observations of iodine supply in school-aged children in Opoczno district (Central Poland). Material and methods A group of 603 children (316 girls and 287 boys), aged 6–14, was examined at 4 time points: in the years 1994, 1999, 2010 and 2016. The children were tested for urine iodine concentration (UIC) and in each child the thyroid volume was measured ultrasonographically. Results The median UIC in 1994 (45.5 μg/l) indicated moderate iodine deficiency, while after introducing prophylaxis it corresponded to adequate values (1999 – 101.1 μg/l, 2010 – 100.6 μg/l, 2016 – 288.3 μg/l); however, the last value was higher than the previous two. The thyroid size, assessed by ultrasonography and presented as volume/body surface area (V/BSA), in 1994 was 6.55 × 10–6 m; this value was higher than at other time points (2.73 × 10–6 m in 1999, 2.73 × 10–6 m in 2010, and 2.70 × 10–6 m in 2016). Conclusions Iodine prophylaxis has proved effective in eliminating iodine deficiency. In recent years, the diversification of iodine sources, despite the reduction of salt consumption, has led to an increase in median UIC to values close to the upper limit of UIC, accepted as normal. Further increase in iodine supply may be unfavourable for health; therefore constant monitoring of iodine prophylaxis is required.

Diabetes and the thyroid

Thyroid disorders are more common in diabetic patients than in the general population. Abnormal thyroid function can be found in as many as 11% to 30% of patients with diabetes mellitus (DM) type 1 or 2. Thus, the Polish Society of Endocrinology and Polish Diabetes Association recommends screening for thyroid dysfunction in all patients with DM. According to these recommendations, concentrations of thyrotropin (TSH) and thyroid peroxidase antibodies (TPOAb) should be measured in every patient with newly diagnosed DM1, and in all patients with DM1 who have never undergone thyroid function tests. In exactly the same situations, patients with DM2 require TSH assessment, while TPOAb titer should be measured only if TSH reaches ≥ 2.0 mIU/L. In diabetic patients with TSH concentration ≥ 2.0 mIU/L and elevated TPOAb level, free thyroxin level should be assessed and – if normal – subsequently TSH should be monitored once a year. If the TSH concentration ≥ 2.0 mIU/L co-occurs with TPOAb titer within the reference range, TSH assessment should be repeated every other year. Patients with TSH < 2.0 mIU/L and normal TPOAb titer should undergo TSH testing every five years. Diabetic patients with a family history of chronic autoimmune thyroiditis require TSH testing once a year. If TPOAb titer is elevated in patients with DM2, the type of DM should be reassessed by measuring the level of antibodies against glutamic acid decarboxylase. Special attention should be paid to women who are pregnant or planning pregnancy. In the preconception period, TSH concentration should be measured in every woman with DM, and in DM1 patients together with TPOAb level. When pregnancy is confirmed, assessment of TSH and TPOAb is advised at the first obstetrician appointment (before 9th week of pregnancy). In all pregnant diabetic patients with a past medical history of Graves’ disease, anti-TSH receptor antibodies (TRAb) should be additionally measured at the first obstetrician appointment and repeated at the end of the second trimester (before the 22nd week of pregnancy). If carbohydrate balance is unimpaired, hyperthyroidism is rarely accompanied by hyperglycemia. Abnormal fasting or postprandial glucose levels in patients with hyperthyroidism indicate increased risk of developing diabetes. In such patients, oral glucose tolerance test (OGTT) should be performed once the euthyroidism is achieved. In diabetic patients, hyperthyroidism causes deterioration of metabolic control of DM and leads to all the systemic consequences of hyperglycemia, including increased risk of ketoacidosis. Additionally, even slight thyroid hormone excess significantly increases the risk of cardiovascular disease in patients with DM. Thus, both overt and subclinical hyperthyroidism should be treated in this group of patients. In diabetic patients with thyroid orbitopathy, the risk of optic neuropathy is increased, and intensive anti-inflammatory treatment should be introduced in every active disease except for the mild course cases. On the other hand, administering high steroid doses in patients with DM adversely influences the metabolic control of diabetes. Hence, in patients treated with oral anti-diabetic medications, periodic insulin therapy should be introduced along with steroid administration. In diabetic patients, also the hypothyroidism is proven to be an independent risk factor for cardiovascular episodes. Therefore, treatment of subclinical hypothyroidism is strongly recommended in this condition. Hypoglycemia or reduced insulin requirement in diabetic patients may indicate concomitant development of hypothyroidism and/ or – especially in patients with DM1 – adrenal insufficiency and polyglandular autoimmune syndrome. Unexplained hypoglycemic states always require hormonal testing to exclude these endocrine disorders.

Qualification for endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of extrahepatic cholestasis caused by choledocholithiasis

Introduction Choledocholithiasis, being the most common cause of extrahepatic cholestasis, is diagnosed on the basis of clinical symptoms, laboratory findings, and imaging results. An important diagnostic and also therapeutic procedure performed in patients with choledocholithiasis is retrograde cholangiopancreatography (ERCP). However, due to the high rate of complications associated with ERCP, the decision on its implementation should be preceded by a thorough analysis of the case, aimed at confirmation of the diagnosis. Material and methods The present study is a retrospective analysis of 86 patients qualified for ERCP due to suspected choledocholithiasis. The diagnosis was based on clinical symptoms and/or laboratory and/or imaging results. The presence of one or more of the three abovementioned criteria was a key to classify patients in one of three risk groups of choledocholithiasis: high, intermediate and low. Results In the high-risk group, where choledocholithiasis was confirmed by clinical symptoms, laboratory findings and results of imaging tests, the accuracy of diagnosis was 100%. In the intermediate-risk group – choledocholithiasis diagnosed on the basis of clinical symptoms and laboratory results – the accuracy of diagnosis was approximately 81.5% (p < 0.05). In the low-risk group, in which choledocholithiasis was diagnosed only on the basis of clinical symptoms, diagnosis accuracy was approximately 50% (p < 0.05). Conclusions The combination of clinical symptoms, laboratory tests and imaging findings allows patients to be classified into three risk groups of choledocholithiasis: high, intermediate and low. Taking into account the probability of choledocholithiasis and the risk of ERCP complications, only patients from high and intermediate risk groups should be qualified for the procedure.