Biomedical subjects
Leszek Czupryniak
Publications and source records attributed to Leszek Czupryniak.
Plasma total homocysteine in the active stage of ulcerative colitis.
BACKGROUND: Homocysteine, an independent risk factor for thromboembolism, has been recently shown to be elevated in ulcerative colitis (UC). However, its relation to the activity of the disease remain unclear. METHODS: Two groups were studied: group consisted of 1-30 patients with UC (17 men, 13 women, mean age 50.3 +/- 14.7 years), including 15 patients with active disease. Group 2 (controls) consisted of 21 age-, sex-, bodyweight-matched healthy persons (12 men, nine women, mean age 53.1 +/- 12.8 years). Total plasma homocysteine (tHcy) and serum folate and vitamin B12 as well as selected coagulation parameters were assessed. RESULTS: Mean tHcy in UC patients was significantly higher than in healthy controls: 10.8 +/- 3.1 mmol/L versus 6.8 +/- 2.5 mmol/L (P < 0.001). Patients with active disease had higher tHcy than patients in remission: 11.2 +/- 3.5 mmol/L versus 9.0 +/- 2.3 mmol/L (P = 0.048). Patients with > or =4 recurrences of the disease had also higher tHcy than the others: 11.5 +/- 3.6 mmol/L versus 9.0 +/- 2.1 mmol/L (P = 0.035). The tHcy correlated with duration of disease: r = 0.6632 (P < 0.05). Folate and B12 levels were within their reference ranges in all subjects. However, in the patients with active disease the platelet count, fibrinogen and D-dimer were significantly higher than in the patients in remission and the controls. CONCLUSIONS: Ulcerative colitis is associated with elevated tHcy concentration, particularly in the active stage, and in more recurrent types of the disease; this elevation does not seem to be prevented by a normal folate status and might have an enhancing effect on the procoagulation blood profile.
Drug-eluting coronary stents.
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Circadian blood pressure variation in morbidly obese hypertensive patients undergoing gastric bypass surgery.
BACKGROUND: Impaired blood pressure (BP) variation, often found in obesity and hypertension, is associated with increased cardiovascular risk. The effect of obesity surgery on BP variation is unknown. We performed this study to investigate the effect of gastric bypass surgery on circadian BP variation in morbidly obese hypertensive subjects. METHODS: The study group consisted of eight patients (mean age 35.0 +/- 9.1 years), with impaired circadian BP rhythm. Controls were eight well-matched subjects (34.6 +/- 9.8 years) with normal BP rhythm. All patients underwent gastric bypass surgery. The 24-h ambulatory BP measurements were performed before (baseline) and 8 weeks after gastric bypass surgery. RESULTS: Mean body weight in the study group and controls decreased from baseline of 129.0 +/- 21.9 kg and 134.1 +/- 27.2 kg to 116.7 +/- 21.1 kg (by 9.5% +/- 2.1%) and 121.6 +/- 25.7 kg (by 9.3% +/- 1.7%) after the surgery, respectively (P < .0001 v baseline). Mean 24-h, daytime, and night-time BP values decreased significantly and similarly in both groups. In the study group mean 24-h systolic and diastolic BP decreased from 154.7 +/- 12.3 mm Hg and 105.6 +/- 8.1 mm Hg to 138.5 +/- 9.3 mm Hg and 90.8 +/- 6.7 mm Hg and in controls from 158.2 +/- 16.5 mm Hg and 106.2 +/- 10.0 mm Hg to 136.3 +/- 10.8 mm Hg and 92.9 +/- 6.3 mm Hg (P < .0001 v baseline), respectively. Circadian BP rhythm in the study group returned to the normal profile (mean systolic nocturnal fall increased from 4.0% +/- 2.4% to 16.4% +/- 4.0% and diastolic, from 5.1% +/- 3.0% to 17.3% +/- 5.5%; P < .0001 v baseline), whereas it remained normal in the controls. CONCLUSIONS: Surgery-induced body weight loss in morbidly obese hypertensive subjects with impaired circadian BP variation is not only associated with BP reduction, but also with the restoration of normal BP rhythm.
Treatment of diabetic ketoacidosis with subcutaneous insulin lispro.
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Treatment with continuous positive airway pressure may affect blood glucose levels in nondiabetic patients with obstructive sleep apnea syndrome.
STUDY OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is often associated with impaired glucose metabolism. Data on the effects of OSAS treatment with continuous positive airway pressure (CPAP) on blood glucose and insulin resistance are conflicting. The study aimed at assessing the immediate effect of CPAP on glucose control measured with a continuous glucose monitoring system (CGMS). PARTICIPANTS AND MEASUREMENTS: Nine non-diabetes subjects with OSAS (mean age 53.0 +/- 8.0 years; body mass index 34.8 +/- 5.3 kg/m2) underwent 2 overnight polysomnographic examinations: a diagnostic study and one with CPAP treatment. Continuous glucose monitoring system (CGMS) was applied overnight on both occasions. Glucose metabolism was assessed with a 75-g oral glucose tolerance test, plasma insulin and homeostatic model assessment of insulin resistance (HOMA-IR) index. RESULTS: The mean (+/- SD) apnoea-hypopnea index (AHI) at diagnostic polysomnography was 54.3 +/- 29.3 (range 16-81). Fasting plasma insulin levels in patients with OSAS was 84.3 +/- 43.4 pM at baseline, and the HOMA-IR was 3.6 +/- 2.2. CPAP treatment in the subjects with OSAS resulted in a significant reduction in the AHI to 4.5 +/- 7.1. All of the major saturation parameters improved significantly on CPAP. CGMS showed mean glucose values significantly higher during the CPAP night than during the diagnostic night: 80 +/- 11 mg/dL versus 63 +/- 7 mg/dL (P < .01). Fasting insulin and HOMA-IR measured after the CPAP night tended to be higher than at baseline (98.4 +/- 51.0 pmol vs 84.3 +/- 43.4 pmol and 3.9 pmol +/- 2.6 vs 3.6 +/- 2.2 pmol, respectively, P > .05). CONCLUSION: CPAP treatment in nondiabetic obese patients with OSAS may have an immediate elevating effect on blood glucose.
Polypropylene mesh in prevention of postoperative hernia in bariatric surgery.
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[Recent discoveries of the early history of insulin production in Poland].
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Polypropylene mesh use in the prevention of incisional hernia.
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Gastric bypass surgery in severely obese type 1 diabetic patients.
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Botulinum toxin A in the early treatment of sixth nerve palsy-induced diplopia in type 2 diabetes.
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[Effectiveness of selected methods of the short-term intensive insulin therapy in patients with poorly controlled type 2 diabetes mellitus].
Poorly controlled type 2 diabetes mellitus can be an indication for hospitalisation and short-term intensive insulin therapy. There are different forms of such therapy i.e. multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) or continuous intravenous insulin infusion (IVII). The aim of our study was to compare the efficacy of these methods of intensive insulin therapy. The following parameters were measured: 1) time period needed for "near normoglycaemia" establishment and 2) mean daily glucose values reduction as a result of the treatment applied. 60 patients with poorly controlled type 2 diabetes (daily blood glucose profile values > 250 mg/dl) treated with insulin twice daily were enrolled into the study. Patients were randomly divided into three groups: CSII, IVII and MDI. CSII as realized through subcutaneous insulin pump model MiniMed 508, IVII through intravenous pump model Duet standard 50-Kwapisz and MDI was based on four insulin injections per day in bolus--basal fashion. Intensive insulin therapy was continued until satisfying daily glucose profile achievement (80-180 mg/dl). After "near normoglycaemia" attainment, a conventional insulin therapy was introduced through subcutaneous insulin dosage. Significant reduction of mean daily glucose values as result of applied treatment was observed in all the groups examined. The degree of glycaemia reduction amounted 60 mg/dl for CSII and 85 mg/dl for IVII. There was no statistical significant difference between treated groups. Mean duration of intensive insulin therapy until "near normoglycaemia" establishment was significantly longer in MDI as compared to CSII and IVII groups (6 days vs. 4.45 and 5.2 respectively). Short-term intensive insulin therapy by MDI, CSII and IVII gives good glycemic control and significantly reduces mean daily glucose values, but this aim can be achieved most quickly using CSII and IVII.
Long-term discontinuation of insulin treatment in a type 1 diabetic patient: a case for late autoimmune diabetes of the adult?
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Long-term efficacy of steady-dose metformin in type 2 diabetes mellitus: a retrospective study.
BACKGROUND: Few data are available on the long-term efficacy of metformin, one of the main drugs in the treatment of type 2 diabetes mellitus. MATERIAL/METHODS: This was a retrospective study of 195 type 2 diabetic patients (109 female, 86 male; mean age 50.4+/-10.1 years, diabetes duration 5.4+/-1.4 years, mean BMI 28.6+/-6.5 kg/m2 at baseline). The inclusion criterion was at least one-year treatment with metformin alone or metformin and one other antidiabetic drug in unchanged doses. The analysis included duration of metformin treatment, mode of therapy, changes in metabolic parameters (fasting blood glucose, HbA1c), body weight, and insulin dosage. RESULTS: Mean duration of metformin use was 970+/-578 (range 373-2916) days, mostly 500 mg tid. 42 patients (22%) were treated with metformin only, 82 (42%) with metformin and sulfonylurea, 61 (31 %) with metformin and insulin and 10 (5%) with metformin and acarbose. In the whole group mean fasting blood glucose decreased during the treatment significantly, from 212+/-57 to 167+/-54 mgldl (p<0.00001), HbA1c from 9.3+/-1.3 to 8.5+/-1.1% (p<0.05), body weight from 92.6+/-17.9 to 88.4+/-14.9 (by 4.5%; p<0.001). A significant positive correlation was noted between baseline body weight and body weight change (r=0.39; p<0.05). Insulin requirement was reduced by a mean of 21 IU/day in the third year of treatment. CONCLUSIONS: Metformin is an efficacious long-term use drug in poorly controlled type 2 diabetes patients, either in monotherapy or in combination.
[Patients' assessment of obesity treatment with Roux-en-Y gastric bypass surgery].
UNLABELLED: Morbid obesity defined as BMI > or = 40 kg/m2 is associated with serious co-morbidities e.g. hypertension, type 2 diabetes mellitus, cardiovascular disease, respiratory insufficiency, sleep apnea syndrome, estrogen-dependent tumors, and degenerative arthritis. Moreover, general results of lifestyle intervention and/or drug therapy in these patients are less than satisfactory. It is widely believed that obesity surgery including gastric by-pass has proved to be an effective method of achieving maintained body weight reduction. The aim of this study was to investigate change in body weight, prevalence of co-morbidities, and quality of life after Roux-en-Y gastric by-pass surgery. 56 patients who underwent Roux-en-Y gastric bypass in 1999-2001 were asked to answer a 42-question-questionnaire. RESULTS: Complete answers were received from 36 subjects (mean (+/- SD) age 39 +/- 10 years, body weight 127.5 +/- 20.4 kg, BMI 4.40 +/- 5.6 kg/m2). Mean post-surgery follow-up time was 24 months. All patients reported significant weight loss (35.8 +/- 10.7 kg). A statistically significant decrease in prevalence of hypertension and various symptoms associated with cardiovascular disease, respiratory insufficiency, sleep apnea syndrome were noted as well as a significant improvement in quality of life. CONCLUSIONS: In morbidly obese patients Roux-en-Y gastric bypass is an effective and long-term well tolerated method of achieving stable weight reduction, leading to improvement in co-morbidities and quality of life.
The use of polypropylene mesh in midline incision closure following gastric by-pass surgery reduces the risk of postoperative hernia.
BACKGROUND: Incisional hernia is a common problem following Roux-en-Y gastric bypass for morbid obesity. PATIENTS AND MATERIALS: We report the preliminary results of nonrandomized prophylactic use of polypropylene mesh in a group of 60 consecutive patients. The patients with highest body mass index, and/or history of abdominal hernias and profound liver damage had abdominal wall reinforced with mesh during an operation. A year later the wound was assessed in all patients. RESULTS: In standard wound closure group (n=48) incisional hernia was found in 9 cases (20%). None of the patients with inserted mesh (n=12) developed hernia. The length of hospital stay in mesh group was similar to that in the nonmesh group and shorter than in patients with hernia occurrence. Mesh insertion was complicated with wound discharge in three patients. CONCLUSIONS: In our opinion prophylactic use of polypropylene mesh in bariatric patients is highly effective in postoperative hernia prevention.
Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome.
Women with polycystic ovary syndrome (PCOS) have a clustering of cardiovascular risk factors, such as obesity, lipid abnormalities, impaired glucose tolerance, insulin resistance, and hypertension. Exercise is reported to lower the incidence of cardiac events. The effect of exercise on plasma homocysteine concentrations, an independent cardiovascular risk factor, has not been previously reported in women with PCOS. We examined the effects of exercise on plasma total homocysteine concentrations in young overweight or obese PCOS women [age (mean +/- SD), 30.6 +/- 6.6 yr; body mass index, 35.49 +/- 7.57 kg/m(2)]. Twenty-one women consented to a 6-month exercise program; 12 women (exercisers) adhered to the program, whereas 9 (nonexercisers) did not. In both groups of women, the following parameters were recorded at baseline and 6 months: body mass index, waist-to-hip ratio, and aerobic capacity (maximal oxygen consumption); blood samples were taken after an overnight fast for plasma total homocysteine, insulin, and other biochemical parameters. A significant decrease in plasma total homocysteine concentrations (P < 0.001) and waist-to-hip ratio (P = 0.041) and a significant increase in maximal oxygen consumption (P = 0.019) were recorded at 6 months, compared with baseline in the exercise group. This decrease in homocysteine was not explained by changes in anthropometric or biochemical parameters. In contrast, no significant changes in any of the variables were observed in the nonexercise group. Our study has provided the first evidence that regular exercise significantly lowers plasma homocysteine in young overweight or obese women with PCOS, a group at increased risk of premature atherosclerosis. The precise mechanism by which exercise is associated with a reduction in homocysteine remains to be elucidated.
Route of corruption in Poland's health-care system.
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