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To assess the recovery of extension and improvement in functional scores after an arthroscopic or open posterior knee capsulotomy in the setting of an extension deficit. A systematic search of articles published between 1980 and 2020 was performed in the MEDLINE/PubMed database, EMBASE/Ovid database and Web of Science database. The inclusion criteria consisted of patients with primary extension deficits > 5° who underwent an arthroscopic or open posterior knee capsulotomy. The assessed outcomes were preoperative and postoperative range of motion and functional outcome scores. Randomized controlled trials, cohort studies and case series with a follow-up longer than 6 months were included. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for case series. The certainty of evidence was assessed using the GRADE approach. Of 226 records identified through database searching, 7 studies were included in the final analysis. The outcomes of 107 patients with a mean age of 34.1 (range 15–63) years were available. In all the included studies, a posterior capsulotomy resulted in the restoration of knee extension to normal or nearly normal values (mean postoperative extension deficit: 0.4–4.2 degrees) with a significant increase in functional outcome scores. No neurovascular complications were reported within the studies. Due to the diverse methodology of studies, the direct comparison of arthroscopic versus open approaches was not possible. Concerning the risk of bias assessment, the greatest concerns raised the selection of participants among the included studies and the methods of outcome measurement. The certainty of evidence was very low according to the GRADE. Both arthroscopic and open posterior capsulotomy of the knee results in restoration of normal or nearly normal knee extension and significant improvement in functional outcomes. IV.

Aim The aim of the study was to assess the blood concentration of orexin and its association with other clinical factors in patients with alcohol dependence. Methods Thirty-two males hospitalized on an addiction treatment ward due to alcohol dependence and 23 healthy men as a control group were enrolled in the study. The measurement of orexin in the blood was made at the beginning of the treatment (after withdrawal symptoms had stopped) and again after 4 weeks of observation. Results At the beginning of the observation, the alcohol-dependent patients had significantly greater orexin blood concentration than the control group. After 4 weeks of treatment for relapse prevention, the blood orexin level decreased significantly to a value similar to that in the control group. At the beginning of the study, more severely alcohol-dependent patients (Short Alcohol Dependence Data [SADD] score range: 20–45) had significantly greater orexin blood concentration than individuals with moderate addiction severity (SADD score range: 10–19). However, after 4 weeks of abstinence, the peptide blood concentration was similar in both groups of alcoholic patients. Conclusions Orexin or its receptor is a potential target for relapse prevention treatment, but further study with long-term observation is needed to verify the usefulness of blood orexin determination as a marker of alcohol relapse risk.

Objective: The aim of this study was to evaluate the concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and the degree of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with morbid obesity exposed to a three-week low-calorie diet and balneotherapy. Methods: The study included 33 patients (25 females and 8 males; mean age 46 years) with body mass index (BMI) values of >40 kg/m2. Evaluations of CRP, IL-6, TNF-α, lipid profile, HOMA-IR, and fasting glucose were carried out before (baseline data) and three weeks after the treatment. The control group consisted of 20 healthy volunteers (15 females and 5 males) with a mean age of 39 years and BMI values of ≤24.9 kg/m2. Results: In the blood of patients with morbid obesity we found significantly elevated levels of CRP, TNF-α, triglycerides, HOMA-IR and fasting glucose, but a decreased level of high density lipoprotein (HDL)-cholesterol, compared with the healthy individuals. The treatment resulted in about a 9.4% reduction in body weight from 122.5 to 111.0 kg and a significant decrease in the concentration of CRP, but no change in TNF-α or IL-6. HOMA-IR was significantly reduced. Conclusions: The decrease in CRP level without changes in TNF-α or IL-6 concentrations after the low-calorie diet and balneological treatment, suggests that an essential amount of adipose tissue must be removed before proper adipocyte function is restored. The decrease in HOMA-IR indicates an improvement in insulin sensitivity, which is beneficial in obese patients.

Objective: In postmenopausal women, an increased leptin concentration and reduced levels of ghrelin and adiponectin were observed. The aim of this study was to evaluate the concentrations of the active form of ghrelin, total ghrelin, leptin receptor, lipoprotein(a) (Lp(a)), and plasminogen activator inhibitor type 1 (PAI-1) in postmenopausal women who received oral or transdermal menopausal hormonal therapy (MHT). Methods: The study involved 76 healthy women: 46 women aged from 44 to 58 years who received oral (26) or transdermal (20) MHT; the control group consisted of 30 women aged from 44 to 54 years who did not receive MHT. The plasma concentrations of total ghrelin, the active form of ghrelin, Lp(a), and PAI-1:Ag were measured by enzyme-linked immunosorbent assay (ELISA). The concentration of the leptin receptor was measured by enzyme immunometric assay (EIA). Results: We observed a significantly higher concentration of total ghrelin and the active form of ghrelin in women who received transdermal MHT in comparison with those who took oral MHT. We also found a significantly lower concentration of total ghrelin in women who received oral MHT compared with the control group. A higher concentration of PAI-1:Ag was found in the group of women who took transdermal MHT in comparison with those who took oral MHT and with the control group. The differences were statistically significant. Additionally, we found a significant negative correlation between the concentrations of total ghrelin and PAI-1:Ag and a positive correlation between the concentrations of total ghrelin and leptin receptor in women who received transdermal MHT. Conclusions: The study showed that women who used transdermal MHT had higher levels of total ghrelin than women who took oral MHT. This indicates a beneficial effect of the transdermal route of MHT. However, transdermal therapy was associated with adverse effects with regard to the observed higher levels of PAI-1:Ag, which in turn, can lead to a reduction in fibrinolytic activity.

Background In patients with intracranial tumors, hypercoagulability is observed due to brain tissue and tumor cells being the source of tissue factor. Objectives The aim of the study was to assess tissue factor (TF), tissue factor pathway inhibitor (TFPI) and protein C in the plasma and tumor tissue homogenate in patients with intracranial tumors. Material and methods The study included 77 patients; 24 patients were diagnosed with glioma, 20 patients with meningioma and 33 patients with metastatic tumors; mean age - 54 years. The material for the study was the plasma and tumor tissue homogenate sampled during surgery. The control group consisted of 30 controls; mean age - 51 years. In the plasma of all the participants and in tumor tissue homogenate, the concentrations of TF-Ag, TFPI-Ag and protein C activity, and the concentration of total protein were measured. The results were converted per mg of protein. Results In patients with intracranial tumors, elevated concentrations of TF-Ag, TFPI-Ag and protein C activity were noted, also after the conversion per mg of protein. A 100-fold higher concentration of TF per 1 mg of protein was found in tumor tissue compared to the patients' plasma. In tumor tissue homogenate, a lower TFPI concentration and a lower protein C activity were recorded. Conclusions The study confirmed the essential prothrombotic properties in patients with intracranial tumors, expressed with an elevated TF level, as well as a tremendous amount of TF in tumor tissue homogenate derived from tumors. The elevated concentration of TFPI and protein C activity converted per mg of total protein should be analyzed in terms of their pleiotropic function, along with the participation in hemostasis control. It seems that the reduced protein C activity and low TFPI level are associated with the enormous TF value in tumor tissue homogenates.

The aim of the study was to investigate whether treatment with non-vitamin K antagonist oral anticoagulants (NOACs) is effective and well tolerated in real-life patients following venous thromboembolism (VTE) associated with severe inherited thrombophilia. We evaluated 33 consecutive patients with severe inherited thrombophilia, defined as the presence of deficiencies in protein C, protein S, or anti-thrombin, homozygous factor V Leiden and prothrombin G20210A mutations, or combined defects. The patients were recruited from March 2010 to December 2015 and followed till July 2016. Rivaroxaban was used in 23 patients (70%), whereas dabigatran and apixaban were used in 4 patients each. During a median 21 (range 8-34) months' follow-up, three recurrent VTE episodes (9%) were observed. Deep vein thrombosis recurred after 6 months on rivaroxaban in a protein S-deficient 32-year-old woman who had heavy menstrual bleeding resulting in interruptions of therapy. A long journey preceded deep vein thrombosis recurrence after 12 months of rivaroxaban use in a 59-year-old obese man homozygous for prothrombin 20210A mutation. The third recurrent VTE following anticoagulation withdrawal prior to surgery and during hospitalization was observed in a 56-year-old woman with protein S deficiency and heterozygous factor V Leiden. The three patients continued use of NOACs, apixaban, dabigatran, and rivaroxaban, respectively. This largest real-life series of patients with severe thrombophilia receiving NOACs indicates that such patients could be safely and effectively treated with NOACs. Lower efficacy was observed in protein S deficiency. Recurrent VTE was mostly related with nonadherence, which highlights an important role of regular intake of NOACs in high-risk patients.

Activated protein C resistance (APC-R) is assessed as part of thrombophilia screening, preferably in patients not taking oral anticoagulants. Rivaroxaban is known to alter some APC-R assays. To our knowledge, there have been no reports on the effect of rivaroxaban on the Russell viper venom time (RVVT)-based APC-R assay in real-life patients. In 168 consecutive outpatients suspected of having venous thromboembolism because of thrombophilia, APC-R was determined using the RVVT-based ProC Ac R assay (Siemens, Marburg, Germany). Patients receiving rivaroxaban or vitamin K antagonists were eligible. We measured rivaroxaban concentrations using the anti-Xa Biophen DiXal assay (Hyphen Biomed, Neuville-Sur-Oise, France) and factor V Leiden using the real-time PCR. APC-R was detected in 23 (28%) patients on rivaroxaban (n = 81) administrated 2-48 h since the blood draw, 15 (28%) patients on vitamin K antagonists (n = 54), and in four (12%) patients off anticoagulation (n = 33). Compared with nonanticoagulated patients, APC-R ratios were similar in patients on rivaroxaban, without any correlation with rivaroxaban concentrations (from 0 to 303 μg/l). None of the patients on rivaroxaban were found to have false-negative or false-positive APC-R ratios. Rivaroxaban concentrations up to 300 μg/l do not affect results of the ProC Ac R RVVT-based assay, which could be recommended in patients referred to a clinic for thrombophilia screening in whom the time since the last dose of rivaroxaban is uncertain.

BACKGROUND The most common cause of death among people with obesity are cardiovascular complications as a result of a hypercoagulability state. OBJECTIVES The purpose of the study was to assess the potential of coagulation system activation depending on the tissue factor and to analyze of the influence of a 3-week low-calorie diet and balneological treatment on selected coagulation parameters in morbidly obese patients. MATERIAL AND METHODS The study included 36 patients (28 females and 8 males; mean age 46) with the value of BMI > 40 kg/m2. The study was designed in two stages: baseline and after 21-days. The evaluation of tissue factor (TF), tissue factor pathway inhibitor (TFPI), von Willebrand factor (vWF), fibrinogen, D-dimer, thrombin-antithrombin complexes (TAT), and the activity of antithrombin (AT) was performed in patients before and after the treatment. The control group consisted of 24 healthy volunteers (16 females and 8 males) at a mean age of 39 with BMI . 24.9 kg/m2. RESULTS There were significantly higher levels of TF, TFPI, fibrinogen, TAT complexes and D-dimer in the study group as compared to the controls. Moreover, there were no significant changes in the parameters studied before and after the treatment. In the group of obese patients, there were significant positive correlations between the concentrations of vWF and BMI and BMI changes and a significant negative correlation between the WHR changes and TFPI concentration. CONCLUSIONS The study confirmed that morbidly obese patients represent a high risk of hypercoagulability state, despite no clinical evidence, which could be due to the great inhibitory potential of TFPI in suppressing the extrinsic pathway of the coagulation system. However, the lack of effect of the 3-week exposure to the LCD and balneological treatment in morbidly obese subjects indicates that substantial fat mass must be reduced before adequate hemostasis is re-established.

Objective To assess the concentration of adiponectin, soluble E-selectin, soluble thrombomodulin and tissue activator plasminogen antigen in postmenopausal women who received oral or transdermal hormone therapy. Design Case–control study. Setting Polish university hospitals. Population Seventy-six healthy postmenopausal women. Method Forty-six women who received oral (n = 26) or transdermal (n = 20) hormone therapy and a control group without such medication (n = 30), all aged 44–58 years. Main outcome measures Plasma concentrations of adiponectin, soluble E-selectin, soluble thrombomodulin and tissue activator plasminogen antigen by enzyme-linked immunosorbent assay. Results We found a significantly higher concentration of adiponectin in women on oral and transdermal therapy in comparison to the control group and a significantly lower concentration of soluble E-selectin in women who received oral hormone therapy vs. the control group. A significantly higher concentration of tissue activator plasminogen antigen was obtained in the group of women using transdermal menopausal hormone therapy compared with those receiving oral therapy and with the control group. Conclusions Reduced levels of soluble E-selectin in women using menopausal hormone therapy could lead to reduction in the intensity of expression of the adhesion factors on the surface of the vascular endothelium. Menopausal hormone therapy might have advantageous effects on vascular endothelial function through adiponectin. Transdermal therapy may have adverse effects associated with elevated tissue activator plasminogen antigen levels and thereby the higher risk of ischemic heart disease.

Introduction Antiphospholipid syndrome (APS) is a common acquired thrombophilia associated with a high thrombotic risk, in which vitamin K antagonists (VKA) represent the mainstay of therapy. Case series involving up to 35 patients with APS suggested limited efficacy and safety of direct oral anticoagulants (DOACs). Material and methods In the prospective case series we followed 56 consecutive patients with APS (44 women and 12 men, aged from 22 to 64 years), including 33 (60%) associated with systemic lupus erythematosus (SLE) and 16 (28.6%) with triple APS who were treated with DOACs due to their preferences or unstable anticoagulation with VKA. DOACs were started at least 3 months since the thromboembolic event in patients with D-dimer below 500 ng/ml. Results Forty-nine (87.5%) patients were treated with rivaroxaban, 4 (7.3%) with dabigatran and 3 (5.4%) with apixaban. During follow-up of 2 to 43 (mean 22) months, 6 (10.7%, 5.8 per 100 patient-years) patients (4 women and 2 men, 4 with triple positive APS) experienced recurrent thrombosis, including deep vein thrombosis (n = 4, including 2 episodes preceded by nonadherence), superficial vein thrombosis (n = 1) and non-ST elevation myocardial infarction (n = 1). The recurrence rate of VTE on DOACs was 5.8 per 100 patient-years. Two patients (3.6%) experienced severe bleeding. Conclusions This case-series suggests that DOACs are safe in patients with APS. These findings need to be confirmed in larger studies.

Obesity is a multifactorial, progressing and life-long illness that consists in an exaggerated collection of fatty tissue. In 1997 WHO acknowledged that overweight and obesity had the character of an epidemic in developed countries. Studies show that in Poland morbid obesity was diagnosed in 2.2% of women and in 0.6% of men. Thromboembolic incidents occur very often in people with obesity, especially with morbid obesity. In hypercoagulability, fibrinolysis process decides about the scale of clinical symptoms of disorders of the hemostasis.The aim of this study was to assess the chosen parameters of the fibrinolysis process in patients with BMI crossing 40, classified for surgical treatment of obesity.The study was conducted in 50 patients with BMI40, including 30 women and 20 men. The mean age of the patients was 38.5 years. The control group was made up of 20 healthy volunteers, with a mean age of 38 years. In the blood of both groups the following examinations were performed: concentration of tissue plasminogen activator antigen (t-PA:Ag), antigen of the plasminogen activator inhibitor type-1 (PAI-1:Ag), D-dimers, fibrinogen and plasminogen, activity of the α2-antiplasmin (α2-AP).The conducted study showed that in patients with morbid obesity there was a higher concentration of tPA:Ag, PAI-1:Ag, D-dimers and a higher activity of α2-AP.The conducted study demonstrates that the activation of the fibrinolysis process appeared after the coagulation process, indicated by an increase in the t-PA:Ag concentration and D-dimers concentration in patients with morbid obesity. The essential growth of PAI-1:Ag level and α2-AP level shows strong inhibition of fibrinolysis in patients.

Objective: The influence of hormone replacement therapy (HRT) on hemostasis processes depends on the type of hormone, the combination of doses, the time of taking HRT, and the route of administration (oral, trans- dermal, implanted). The aim of the current study was to assess some parameters of coagulation, especially tissue factor pathway inhibitor (TFPI) and tissue factor (TF) in postmenopausal women using oral or transdermal HRT. Methods: The study was conducted on 76 healthy women, including 46 women aged 44-58 years who were taking oral (26) or transdermal (20) HRT, and 30 women aged 44-54 years who did not take HRT as the control group. Plasma concentrations of TF, TFPI, thrombin-antithrombin complex (TAT), and D-dimer were performed by enzyme-linked immunosorbent assay (ELISA). Moreover, the concentration of fibrinogen and activity of protein C were measured by chromogenic and chronometric methods. Results: We observed a significantly higher concentration of TF and a sig- nificantly lower concentration of TFPI in women taking oral and transdermal HRT in comparison with the control group. We also found a significantly lower concentration of fibrinogen in women taking oral HRT vs. the control group. Moreover, no statistically significant changes in concentrations of TAT and D-dimer, or activity of protein C were noted. Conclusions: In this study, the occurrence of an increased TF concentration simultaneously with a decreased con- centration of TFPI in women taking HRT indicates hypercoagulability. No significant modification of TAT or D-dimer occurred, and thus there may not be increased risk of thrombosis.

Persistent organic pollutants (POPs), such as PCBs (polychlorinated biphenyls) and DDT [1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane], are environmental contaminants with potential endocrine disrupting activity. DNA methylation levels in peripheral blood lymphocytes have been associated with serum concentrations of POPs in Greenland Inuit and Korean populations. Greenland Inuits are characterized by the highest worldwide POP levels. In this cross-sectional study we evaluated the relationship between serum POP concentrations and DNA methylation levels in sperm of non-occupationally exposed fertile men from Greenland, Warsaw (Poland), and Kharkiv (Ukraine). Serum levels of PCB-153 [1,2,4-trichloro-5-(2,4,5-trichlorophenyl)benzene], as a proxy of the total PCBs body burden, and of p,p'-DDE [1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene], the main metabolite of DDT were measured. Sperm DNA methylation level was assessed globally by flow cytometric (FCM) immunodetection of 5-methyl-cytosines and at specific repetitive DNA sequences (Alu, LINE-1, Satα) by PCR-pyrosequencing after bisulfite conversion. Multivariate linear regression analysis was applied to investigate correlations between serum POP concentrations and DNA methylation. No consistent associations between exposure to POPs and sperm DNA methylation at repetitive DNA sequences were detected. A statistically significant global decrease in methylation was associated with exposure to either POP by FCM analysis. This is the first study to investigate environmental exposure to POPs and DNA methylation levels considering sperm as the target cells. Although POP exposure appears to have a limited negative impact on sperm DNA methylation levels in adult males, the global hypomethylation detected by one of the methods applied suggests that further investigation is warranted.

The goal of this paper is to determine concentrations of seven selected perfluoroalkylated substances (PFASs): perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorododecanoic acid (PFDoDA) in the blood serum of men and women of reproductive age from the central region of Poland. The relation between sex of tested subjects and the levels of compounds in blood serum of humans will also be considered and analysed as an element of the risk assessment. The study was made on the blood serum samples collected from 253 women and 176 men of reproductive age between 20 and 44 years from Warsaw and surrounding areas. Higher concentrations of five (PFOS, PFOA, PFNA, PFDA, PFUnDA) from among seven selected PFASs were observed in men in comparison to women from the same populations. Only the concentrations of PFHxS and PFDoDA were slightly higher in women than in men. These differences were statistically significant in all cases, except for PFUnDA. The hypothesis that the concentrations of said compounds increase with age of the test subjects, regardless of gender has not been confirmed.

Organohalogen compounds constitute one of the important groups of persistent organic pollutants (POPs). Among them, due to their long-term health effects, one should pay attention on organochlorine pesticides, polychlorinated biphenyls (PCBs) and perfluoroalkylated substances (PFASs). This paper is an attempt to answer the question about relation between the fact of cohabitation by couples expecting a child and the level of the organohalogen compounds in the blood serum of both parents. The study was done on a population of parent couples from Greenland, Poland and Ukraine, from whom blood samples were collected in order to establish the levels of marker organohalogen compounds. We selected, as the representative of these compounds, the most persistent metabolite of DDT, i.e. p,p'-DDE, the most frequently detected PCB congener - CB-153, and PFOS and PFOA as the representatives of PFASs. The results show that in case of all compounds under study the highest concentrations were present always in men in relation to the levels detected in the blood serum of their female partners, regardless of the country of origin of the couple. A positive correlation was noted between the concentrations of the studied compounds in the blood serum of men and women in parenting couples. In some cases these correlations were statistically significant, e.g. for concentrations of p,p'-DDE in pairs from Greenland and Ukraine, of CB-153 in pairs from Poland and Ukraine, and of PFOS for parents from Greenland and Poland, while for PFOA - only for couples from Greenland. The concentrations of the compounds included in the study were similar to the levels found in general population in other countries. Our results show that the exposure to POPs resulting from cohabitation plays a role in the general exposure to these compounds.

To investigate whether baseline triglyceride levels are associated with early glucose dysregulation and/or cardiovascular risk in women with a previous history of gestational diabetes.Prospective postpregnancy cohort study.Polish university hospitals.Participants included 125 women with previous gestational diabetes and 40 women with normal glucose regulation during pregnancy.All women were studied 2-24 months (mean 12 ± 10 months) after the index pregnancy. Women with previous gestational diabetes were divided into tertiles in accordance with baseline triglyceride levels.We assessed glucose regulation (oral glucose tolerance test), insulin resistance (homeostasis model assessment), markers of endothelial dysfunction (soluble: intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, tissue plasminogen activator antigen, von Willebrand factor antigen), fibrinolysis (plasminogen activator inhibitor antigen), inflammation (high-sensitivity C-reactive protein) and lipid levels.Women with previous gestational diabetes (78% normal glucose regulation, 22% impaired glucose tolerance) had a high cardiometabolic risk profile compared with control women (100% normal glucose regulation). Baseline triglycerides0.83 mmol/l were associated with a higher prevalence of impaired glucose tolerance, higher high-sensitivity C-reactive protein and triglyceride/high-density lipoprotein-cholesterol ratio. Triglycerides1.22 mmol/l were associated with higher body fat indexes, higher insulin resistance, higher levels of endothelial dysfunction biomarkers, higher plasminogen activator inhibitor antigen and dyslipidemia. Only E-selectin was independently associated with triglyceride levels.Baseline triglyceride levels are a cardiovascular risk marker as well as a pathophysiological parameter independently associated with endothelial dysfunction in nondiabetic women with previous gestational diabetes at 2-24 months after an index pregnancy. Normalization of triglycerides should be included in preventive therapy after a pregnancy complicated by gestational diabetes.

Persistent organic pollutants (POPs) may affect male reproductive function. Many dioxin-like POPs exert their effects by activation of the aryl hydrocarbon receptor (AHR) signalling pathway. We analysed whether gene-environment interactions between polymorphisms in AHR (R554K) and AHR repressor (AHRR P185A) and serum levels of markers of POP exposure 1,1-bis-(4-chlorophenyl)-2,2-dichloroethene (p,p'-DDE) and 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) are associated with 21 parameters of male reproductive function in 581 proven-fertile European and Greenlandic men. In Greenlandic men, AHR variants significantly modified the association between serum levels of both p,p'-DDE and CB-153 and inhibin B levels, sperm chromatin integrity, and seminal zinc levels. In the total cohort, interactions between AHRR variants and serum levels of CB-153 were associated with sperm chromatin integrity and the expression of the pro-apoptotic marker protein Fas. The data indicate that susceptibility to adverse effects of POP exposure on male reproductive function is dependent on polymorphisms in genes involved in AHR signalling. © 2014 Elsevier Inc.

An attempt was made to understand how consecutive deliveries and the following lactations have an impact on the organochlorine compound levels detected in human milk. The other goal of the study was to check for a possible dependence between fat content and the levels of the studied compounds in milk samples from the same lactations. 199 milk samples were examined for the presence of p , p ′ -DDT, p , p ′ -DDE, p , p ′ -DDD, α-, β-, γ-HCH and ∑PCBs. Moreover, in 87 milk samples the fat content was additionally determined. This study has indicated that, for the mother with a shorter interval between lactations, mean concentrations of the examined compounds were higher in the milk of the first lactation than that of the second. For the other donor whose second lactation began after 2 years, the mean levels of HCB, β-HCH, p , p ′ -DDD, and PCBs in her milk were higher during the first lactation. At the same time, the concentrations of p , p ′ -DDT and p , p ′ -DDE after the second delivery were slightly higher. The correlation coefficients between the two data sets (fat content in milk, concentrations of the compounds studied in milk) showed no interrelationship between them.

This study was an attempt to identify if there are any trends in excretion of 1,2,3,4,5,6-hexachlorocyclohexane (HCH) isomers alpha-, beta-, and gamma-, hexachlorobenzene (HCB), [1,1,1-trichloro-2, 2-bis(4-chlorophenyl)ethane] (p,p'-DDT), [1,1-dichloro-2, 2-bis(4-chlorophenyl)ethane] (p,p'-DDD), [1,1-dichloro-2, 2-bis(4-chlorophenyl)ethylene] (p,p'-DDE), and polychlorinated biphenyls (PCBs) with human milk during lactation. The shortest lactation studied took 16 weeks, and the longest 84 weeks. Three hundred fifty-two milk samples, collected from each donor once a week, were examined. The analysis of the result showed individual differences in the excretion of the compounds. The findings from this study are not conclusive enough to claim that there are consistent trends showing a decrease or increase in the excretion of the compounds under examination. Thus, one cannot claim that the infants' exposure to those compounds decreases or increases as breast-feeding continues.

The purpose of this study was to assess human exposure in the prenatal period to selected PBDEs (BDE-47, BDE-99, BDE-153) and PCBs (CB-77, CB-101, CB-118, CB-126, CB-138, CB-153, CB-170, CB-180) basing on the analysis of these compounds in cord blood. The experimental material consisted of 89 cord blood samples taken from women resident in Warsaw and its vicinity. In over 90% of all tested samples the presence of congeners CB-153, CB-138, CB-180 and BDE-47 was identified. The least frequently found were CB-126 and BDE-153, which were present at relatively low concentration levels. Among all analysed PCBs, the highest average concentrations were found in the case of congeners CB-138 (11.8 ng/g of fat) and CB-153 (43.4 ng/g of fat), whereas the lowest was in the case of CB-170 (0.4 ng/g of fat) and CB-126 (0.1 ng/g of fat). In the case of PBDEs the greatest share in the total concentration was that of the congeners BDE-47 and BDE-99, whereas the smallest share was that of the higher brominated congener BDE-153. These results suggest that human exposure to the examined compounds begins already in the period of intrauterine life. The comparison of our own results with the findings of other authors indicates that the PCBs and PBDEs levels in cord blood of women living in Poland do not differ from the respective concentrations in cord blood of other female inhabitants of Europe.

Recently, it has been reported that nonstenotic bicuspid aortic valve (BAV) with dilated proximal aorta is linked with increased matrix metalloproteinase-2 (MMP-2) and endothelial dysfunction.We wondered whether asymmetric dimethylarginine (ADMA), a nitric oxide synthase inhibitor, might be altered and associated with MMP-2 in BAV patients. We assessed the relation between ADMA levels and aortic diameters and hypothesized that elevated ADMA might be an independent predictor of progressive aortic dilatation in BAV patients.We studied 20 patients with nonstenotic BAV (17 men and 3 women, median age 27, range 24-33 years). Twenty age-matched patients with tricuspid aortic valves served as controls. Plasma levels of ADMA, symmetric dimethylarginine (SDMA), L-arginine, serum MMP-2, MMP-9, and plasma total homocysteine (tHcy), together with parameters of aortic elasticity, were measured.ADMA and MMP-2 levels were higher in the BAV group compared with controls (medians, 0.55 vs. 0.43 μmol/l, P0.001 and 1.25 vs. 1.00 μmol/l, P0.001, respectively). The BAV patients also had higher SDMA and tHcy levels than controls (0.39 vs. 0.35 μmol/l, P0.001 and 11.5 vs. 9.7 μmol/l, P = 0.006). ADMA levels in BAV patients correlated with aortic annulus (r = 0.4, P = 0.043), peak aortic velocity (r = 0.6, P = 0.001), aortic distensibility (r = 0.6, P = 0.004), aortic stiffness index (r = 0.7, P0.001), and aortic strain (r = 0.7, P0.001) as well as with MMP-2 (r = 0.6, P = 0.002) and tHcy (r = 0.4, P = 0.042).This study is the first to show that circulating ADMA together with MMP-2 is a marker of proximal ascending aortic dilatation and impaired aortic elastic properties in nonstenotic BAV patients. It might be speculated that plasma ADMA could be helpful in identifying BAV patients at a higher risk of aortic aneurysm.

The brominated diphenyl ethers (PBDEs) belong to a class of synthetic, additive brominated flame retardants (BFRs). PBDEs are used to reduce the flammability of commercial and household products such as textiles, various plastic polymers, furnishing foam, and electronic equipment. People spend a large percentage of their life-time indoors at home, in offices and cars, etc, providing many opportunities for lengthy exposure to PBDEs from residential settings and commercial products in an indoor environment. In recent time, the foodstuffs, mainly food of animal origin, have been indicated as the main pathway of human exposure to PBDEs. However, many studies have shown that the indoor environment, mainly indoor dust, can be also a significant source of exposure to PBDEs, especially for younger children (toddlers) because of their behavioral patterns, eg. putting fingers, toys, and other items in their mouth. Numerous studies show that the median intakes of PBDEs via dust for adult range from 1.41 to 277 ng x day(-1) is lower than that via food which range from 135 to 333 ng x day-', while the median intake of these compounds via indoor dust for children range from 101 to 404 ng x day(-1) is much higher than via food: 77-190 ng x day(-1). The congener pattern observed in the indoor dust is different to that found in food. The indoor dust is dominated by the congener BDE-209 vs. food where the most dominated congeners are BDE-47 and BDE-99. Human exposure to PBDEs and other brominated flame retardants (BFRs) is widely widespread throughout the world and it depends on a country range of usage, production and legislation concerning these chemicals as well as a citizen's behavior. Generally, human exposure has been found higher in North America than in Europe and Asia. Within European countries the significant highest concentrations in dust have been found in the United Kingdom. It should be noted that many uncertainty factors such as personal habits, dietary preferences, and time spent in various rooms, cars and outdoors could affect the exposure assessment. In some cases the occupational exposure is the most important source of PBDEs for adults, for example air crews, car sale employees and disposal/recycling of electronic waste workers.

This study aimed at the generation of preliminary results allowing for the assessment of breastfed infants exposure to polybrominated diphenyl ethers (PBDEs) which constitute important contaminants in places of human habitation. The second goal was to compare the concentrations of these compounds with other contaminants which people are exposed to via food chain. 28 breast milk samples from women living in Warsaw and neighbourhood were analyzed for polybrominated diphenyl ethers (BDE-47, BDE-99, BDE-153), polychlorinated biphenyls (CB-77, CB-101, CB-118, CB-126, CB- 138, CB-153, CB170, CB-180) and organochlorine pesticides (HCB, β-HCH, γ-HCH, p,p'-DDE, p,p'-DDD, p,p'-DDT). The ΣDDT levels noted in our studies were higher than in other European countries. The concentrations of the examined polychlorinated biphenyls and polybrominated diphenyl ethers did not diverge from the levels presented by other authors and are comparable to the levels noted in other countries in Europe.

Direct spectrophotometry has been recognized as a standard reference method in the treatment of victims of carbon monoxide (CO) poisoning. Recently, Masimo (USA) has developed a pulse oximeter for the detection of HbCO. Using new probes, similar to those used for traditional pulse oximetry, several different light wavelengths enable detection of different haemoglobins.We have compared forty-nine capillary blood samples taken from patients admitted to the hyperbaric center with CO poisoning. The samples were analyzed using direct spectrophotometry (HbCO) and compared with the corresponding pulse CO-oximeter (SpCO) readings. The Bland-Altman method was used for statistical analysis.The mean HbCO concentration was 18.1+/-12.7% (range 0.1% to 47.4%) and the mean SpCO concentration, 17.6+/-11.3% (range 1.0% to 46.0%). There was a strong positive correlation between laboratory results and bedside readings (r2=0.88). The mean difference between readings was 0.5+/-4.3% (range -11.0% to +9.0%), and the distribution was uniform over the whole range of measured levels. For detection of HbCO levels higher than 20%, the sensitivity of the pulse-CO-oximeter was 77.8%, PPV 82.4%, specificity 90.3%, and NPV 87.5%.Our study confirmed the accuracy of pulse CO-oximetry for rapid detection of the presence and concentration of HbCO. Since this method is based on analysis of peripheral blood flow, it is not clear if it could be used in patients with low perfusion, hypothermia or burns.

A serious diving accident can occur in recreational diving even in countries where diving is not very popular due to the fact that diving conditions there are not as great as in some tropical diving locations. The estimated number of injured divers who need recompression treatment in European hyperbaric facilities varies between 10 and 100 per year depending on the number of divers in the population, number of dives performed annually, and number of hyperbaric centres in the country. In 5 years of retrospective observation in Poland (2003-2007) there were 51 cases of injured recreational divers recorded. They either dived locally or after returning home by air from a tropical diving resort. All of them were treated with recompression treatment in the National Centre for Hyperbaric Medicine in Gdynia which has capability to treat any patient with decompression illness using all currently available recompression schedules with any breathing mixtures including oxygen, nitrox, heliox or trimix. The time interval between surfacing and first occurrence of symptoms was significantly lower in the group of patients with neurological decompression sickness or arterial gas embolism (median 0.2 hours) than in the group of patients with other types of decompression sickness (median 2.0 hours). In both groups, there were different types of recompression tables used for initial treatment and different number of additional sessions of hyperbaric oxygenation (HBO) prescribed, but the final outcome was similar. Complete resolution of symptoms after initial recompression treatment was observed in 24 cases, and this number was increased to 37 cases after additional HBO sessions (from 1 to 20). In the final outcome, some residual symptoms were observed in 12 cases. In 2 cases initial diagnosis of decompression sickness type I was rejected after initial recompression treatment and careful re-evaluation of diving profiles, risk factors and reported symptoms.

Transformed cells of solid tumors often contain activators of fibrinolytic system allowing to create new metastatic centers. There are a few data of fibrinolytic potential of neoplastic cells of hematopoietic system. The aim was the evaluation of t-PA (tissue plasminogen activator) and PAI-1 (inhibitor of plasminogen activator type 1) in lymphocytes datained from patients with chronic lymphoid leukemia.The study was performed in 35 patients with chronic lymphoid leukemia and in control group containing 20 healthy persons. From venous blood lymphocytes were isolated, calculated and homogenized using ultrasound disintegrator. In homogenates of cells and in the blood plasma concentrations of t-PA antigen (t-PA:Ag) and antigen of PAI-1 (PAI-1:Ag) were determined.In lymphocytes obtained from healthy persons more t-PA and PAI-1 was detected than in lymphocytes from patients with chronic lymphoid leukemia. In lymphocytes from patients PAI-1: Ag concentration was 14 fold higher than t-PA:Ag.The lymphocytes of patients suffering from chronic lymphoid leukemia are different from healthy person in respect of t-PA:Ag and PAI-1:Ag concentration.

Polybrominated diphenyl ethers (PBDE) because of their physical and chemical properties belong to Persistent Organic Pollutants (POPs). They are stable in the environment and due to lipophilic properties, have potential impact to human health. Currently these compounds are present in all kind of environmental samples all over the world. Levels of PBDE in samples originated from U.S. are higher than levels reported from Europe and Japan, what may be linked to common use these flame retardants in this country. Environmental (including humans) concentration of PBDE have increased rapidly in the last decade. Predominant congeners detected in all matrices are BDE-47, -99, -153, -209. Recent Swedish report however noticed decrease of PBDE concentrations what can be consequence of phase-out of these compounds in this country. It has been suggested that the environmental levels of PBDE may influence human nervous and immunological system as well as they may disrupt hormonal homeostasis. Research studies suggest also that the exposure to polybrominated diphenyl ethers may be associated with increased risk of cancers. Therefore, continuation of research concerning occurrence and toxicity of PBDE has reasonable grounds.

Maximum Residue Levels (MRLs), as legally binding normative values, have appeared in Polish food legislation for the first time in 1993. Currently, existing MRLs include those values implemented from EU Directives and National MRLs set up by experts from the National Institute of Hygiene. Monitoring of pesticide residues allows to assess exposure of consumers to these compounds present in food products. Monitoring results can also influence the scope of plant protection products application, and change in MRLs. Another tool used to check compliance of food products with MRLs is official control of foodstuffs. Poland, since its accession to the European Union in 2004 takes part in the EU coordinated monitoring programme and carries out the official control of pesticide residues in foodstuffs. Food present on the market must not contain pesticide residues at level exceeding legally binding MRLs. Each case of MRLs violation requires performing of individual risk assessment. In such case so called Predicted Short Term Intake from sampling result (PSTI) is calculated and compared to ARfD or to ADI. Such an assessment is applied to a high percentile of consumption (97,5) among general population (adults) and among the most vulnerable consumer group (children aged 1,5 up to 6 years old). Depending on the results of the assessment, the information about MRL exceedances may be notified to the Rapid Alert System for Food and Feed (RASFF) by the Polish Contact Point placed in Chief Sanitary Inspectorate. In Poland, the risk assessment for MRLs violations is performed in the National Institute of Hygiene. The result of risk assessment is a basis for Chief Sanitary Inspector to undertake appropriate risk management decisions to eliminate of potential health risk for consumers.

Since artherosclerosis processes were proved to have their origins as early as in one's childhood, attempts have been made to find the risk factors in the population of the developmental age.The aim of this work was the analysis of lipidogram parameters and the parameters of coagulation and fibrynolysis systems in overweight and obese children and adolescents.101 children and adolescents aged 4-19 were examined, including 30 overweight and 34 obese ones, with the control group comprising 37 patients with normal body weight.No significant differences in the studied groups were noticed in the total cholesterol level, LDL, fibrinogen and in alpha2-antiplasmin activity. The HDL cholesterol level was actually lower in the group with obese patients, while the PAI-1 level was actually higher.Overweight and obese children and adolescents comprise a group threatened by premature development of atherosclerosis and need to be monitored for risk factors.

Insulin resistance may coexist with diabetes type 1 and make treatment of diabetes difficult. Case of 24-year-old type 1 diabetic female with insulin resistance features prior to pregnancy is reported. Exacerbating of insulin resistance during pregnancy was manifested by difficulties to overcome excessive weight gain and necessity to initiate treatment with high doses of insulin. The treatment was based on diet with progressive caloric restriction to 800 kcal/day in 35 week of pregnancy. That diet was continued till the delivery in 37 week. The fast acting analog insulin (Humalog) and long acting insulin (Humulin U) were used in treatment of diabetes. Treatment with low calorie diet did not cause negative effects on diabetic female metabolism and on the neonate state.

In June 2004, blood samples of fifteen volunteers were analyzed for presence of selected groups of chemical contaminants. The aim of this survey organized by WWF Poland (World Wildlife Fund) was highlighting the problem of man-made, persistent and bioaccumulative chemicals constantly present in surrounding environment and in our tissues. It was a part of European WWF "Detox" campaign supporting proposal of a new EU regulation that should lead to the identification and phasing out of the most harmful chemicals (known as REACH). Three laboratories in Czech Republic, Sweden and Belgium have analyzed blood samples for presence of the following groups of contaminants: organochlorine compounds (pesticides and polychlorinated pesticides), phthalates and perfluorinated aliphatic substances. The total number of single chemicals found in the blood samples was 25, that represents 64% of the 39 chemicals looked for. The average number of compounds found in the samples was 21 (from 19 to 22). Among organochlorine compounds analyzed, the predominant chemical found in the highest concentration was p,p'-DDE (range from 130 to 1310 ng/g of fat), which similarly like p,p'-DDT, beta-HCH, and HCB (concentrations ranging from 6,4 to 46 ng/g of fat) was present in every person's blood. Among analyzed polychlorinated biphenyls, in all samples the following congeners have been present: PCB-118, PCB-138, PCB-153, and PCB-180 (concentrations ranging from 3,7 to 61 ng/g of fat). The two predominant phtalates from total eight analyzed present in all samples were di(2-ethylhexyl)phthalate (DEHP) (concentration range from 49 to 293 ng/g of blood) and diisobutyl phthalate (DIBP) (concentration range from 10 to 63 ng/g of blood). Among fifteen perfluorinated aliphatic substances analyzed, six have been present in each single sample (perfluorohexanesulfonic acid - PFHxS, perfluorooctanoic acid - PFOA, perfluorooctane-sulfonic acid - PFOS, perfluorooctanesulfonylamide - PFOSA, perfluorononanoic acid - PFNA, and perfluorododecanoic acid - PFDA). The predominant compound in this class of contaminants was PFOS with the concentration ranging from 4,4 to 14 ng/ml of blood. The limited number of samples does not allow for making an analysis of potential impact of different factors on concentrations of particular contaminants in human blood. Results obtained in this survey confirm the ubiquitous contamination by a cocktail of hazardous chemicals of every person tested. Humans being a part of the environment are being contaminated with the same chemicals which are present in surrounding air, water, food, consumer articles, etc.

Gestational diabetes mellitus (GDM) has heterogeneous ethiopathogenesis, pathophysiology and clinical features.The aim of the study was to evaluate some of anthropometric parameters, clinical features and indices of insulin resistance and beta cell function in GDM women in first pregnancy and in GDM women in third and following pregnancies.877 GDM women, aged 18-48 years were studied. Both groups were compared according to age, BMI before pregnancy, week of GDM diagnosis, weight gain during pregnancy, fasting blood glucose, fasting serum insulin level, HbA1c, insulin resistance and beta-cell function indices. All parameters except BMI were evaluated at GDM diagnosis.Multiparas were older, with higher BMI and lower beta-cell function indices.At the moment of GDM diagnosis, insulin secretion evaluated by HOMA indices are lower in multiparas in comparison to primaparas.

Background The study is part of a collaborative project (Inuendo), aiming to assess the impact of dietary persistent organochlorine pollutants (POPs) on human fertility. The aims with the present study are to analyze inter-population variations in serum concentrations of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE), to assess inter-population variations in biomarker correlations, and to evaluate the relative impact of different determinants for the inter-individual variations in POP-biomarkers. Method In study populations of 3161 adults, comprising Greenlandic Inuits, Swedish fishermen and their wives, and inhabitants from Warsaw, Poland and Kharkiv, Ukraine, serum concentrations of CB-153 and p,p'-DDE, were analysed by gas chromatography-mass spectrometry. Results The median serum concentrations of CB-153 were for male and female Inuits 200 and 110, for Swedish fishermen 190 and their wives 84, for Kharkiv men and women 44 and 27, and for Warsaw men and women 17 and 11 ng/g lipids, respectively. The median serum concentrations of p,p'-DDE were for Kharkiv men and women 930 and 650, for male and female Inuits 560 and 300, for Warsaw men and women 530 and 380, and for Swedish fishermen 240 and their wives 140 ng/g lipids, respectively. The correlation coefficients between CB-153 and p,p'-DDE varied between 0.19 and 0.92, with the highest correlation among Inuits and the lowest among men from Warsaw. Men had averagely higher serum concentrations of CB-153 and p,p'-DDE, and there were positive associations between age and the POP-biomarkers, whereas the associations with BMI and smoking were inconsistent. Dietary seafood was of importance only in the Inuit and Swedish populations. Conclusion CB-153 concentrations were much higher in Inuits and Swedish fishermen's populations than in the populations from Eastern Europe, whereas the pattern was different for p,p'-DDE showing highest concentrations in the Kharkiv population. The correlations between the POP-biomarkers varied considerably between the populations, underlining that exposure sources differ and that the choice of representative biomarkers of overall POP exposure has to be based on an analysis of the specific exposure situation for each population. Age and gender were consistent determinants of serum POPs; seafood was of importance only in the Inuit and Swedish populations.

Cavity in lung cancer patients is usually attributed to worse prognosis, which could be caused by diagnostic difficulties and late surgery. The aim of this study is to identify cavity as clinical subentity in squamous cell lung cancer (SqCLC) patients. 1094 patients with I0 - III0 of SqCLC underwent surgery with the purpose of radical lobectomy or pneumonectomy. The patients were divided into two groups: 100 patients with cavity (cSqCLC) and 994 with solid tumor (sSqCLC). The clinical, histological and prognostic features were compared for the both groups. The Cox multivariate analysis of the prognostic factors was performed. The survival curves for both groups were compared. cSqCLC patients showed lower body mass and more frequent hemoptoe. They had larger tumors, located peripherically, rarer nodal involvement and atelectasis. Despite the similar cancer stage and the exploratory thoracotomies ratio, cSqCLC patients lived shorter. The survival curves for both groups were different: in all population, for patients after radical surgery and even after exploratory thoracotomy. We conclude that the cavitation in SqCLC patients can be regarded as a separate subentity related to worse prognosis.

Although manufacture and use of chlorinated insecticides was banned or severely restricted in most of countries in the 1970s, the residues of these compounds are still detected in various environmental matrices all over the world. Their highest levels are found in adipose tissue of beings at the top of food chain, including humans. Levels of persistent organochlorine compounds in human specimens are monitored by numerous scientific organizations in various countries, including Poland. The purpose of the study was to survey the current levels of selected organochlorine insecticides (isomers alpha-, beta-, gamma-, delta-HCH, o,p'- and p,p'-DDT, DDE i DDE, oxy-chlordane and heptachlor) in women's breast adipose tissue which can be an indicator of body burden. A total of 67 samples of adipose breast tissue collected between 1997 and 2001 from non-cancer patients, aged from 15 to 74 years have been analyzed. The analytical procedure included extraction, clean-up and analysis by means of GC-ECD with GC-MS confirmation. In all the samples analyzed p,p'-DDE, p,p'-DDT and beta-HCH were present (mean values, expressed as mg/kg of fat: 0.7700, 0.0720, and 0.0635 respectively) with p,p'-DDE, found to be dominant analyte. The levels of the remaining compounds, were usually about or below the method quantification limits (from 0.0025 to 0.0060 mg/kg of fat). The results for DDTs and beta-HCH for the oldest group (above 50 years) were 2.1 to 3.6 times higher than the youngest group (below 39 years). The results obtained in this study are similar to those reported in analogous samples collected from women living in other European countries with similar climate and history or organochlorines usage as well as in the USA. The presence of some organo-chlorine insecticide residues in women's adipose tissue, even those, who were born even 10-15 years after most countries introduced severe restrictions or banned the use of these compounds may be cause for anxiety. That is due to the potential of these compounds to promote toxic effects, including disrupting the human endocrine system.

Aim of study was to summarize six-year institutional experience with serial evaluation of circulating CA15-3 antigen as a method of early detection of breast cancer relapse.CA15-3 concentrations were assayed immuno-enzymatically in the sera of 733 women with breast carcinoma: in 707 cases marker was analyzed serially (every 4 months during follow-up after completion of radical treatment and when the relapse of breast cancer was clinically suspected) and in 26 patients--at diagnosis of locoregional relapse and\or breast cancer dissemination; 5493 assays of the CA15-3 antigen were performed in total. The cut-off limit was established at 30 u/ml. Results of CA15-3 tests were analyzed in relation to clinical status of the disease and dominant site of breast cancer relapse.1) in patients with distant metastases (N = 149), mean serum CA15-3 values and the percentage of positive results were significantly higher as compared to cases with locoregional relapse and carcinoma of the contralateral breast (N = 54; p0.0001) and those without clinical evidence of relapse (N = 530; p0.0001), in agreement with previous studies; 2) the highest mean values of CA15-3 were observed in patients with liver and multiple metastases, lower in those with bone or lung secondaries, and the lowest when the metastatic involvement of supraclavicular nodes was noticed; 3) the CA15-3 sensitivity rates were higher in patients with liver or bone metastases (91.7% and 91.4%, respectively), as compared to those with multiple (79.5%) and lung (72.4%) secondaries, and the lowest when metastases in supraclavicular nodes (40.0%) or other organs (60.0%) were diagnosed; 4) the comparison of subjects with liver secondaries and those with other sites of breast cancer dissemination indicated statistically significant difference in the mean CA15-3 values (p0.0001) and the number of positive results of the test (p0.05); 5) the sensitivity rates of CA15-3 antigen for one, two, three and more skeletal metastases detected by bone scintigraphy were 50%, 100% and 100%, respectively (N = 30); 6) in 84 out of 116 (72.4%) patients with distant metastases, the increased CA15-3 concentration preceded the clinical diagnosis of the relapse with the median lead time 9 months (range: 1-40); 7) the highest positivity rates of the lead time were observed in patients with liver or lung metastases (93.8% and 81.0%, respectively) and the lowest one in those with multiple sites of metastases (43.0%).The study confirmed the validity of serial CA15-3 assays in the early diagnosis of breast metastatic disease. It is worth to emphasize the high sensitivity of the CA15-3 test in detecting bone metastases (100% in patients with scintigraphically diagnosed two or more metastatic lesions), but the group of patients was too small to make our observation conclusive. In none of the studies published previously, the beneficial impact of serial CA15-3 assays during follow-up on survival and quality of life in breast cancer patients was clearly demonstrated. Thus, modifying treatment based solely on increasing marker levels is not recommended.

Ninety-three patients with pulmonary metastases (PM) were operated on between 1983 and 1997. Surgical complications occurred in 8 (9%) of patients. Two (3%) of patients died in hospital, 7 were operated on again due to further PM. An average survival after lung metastasis surgery was 40 months, median 22 months. 44% and 35% of patients survived respectively 3 and 5 years. Thanks to lung metastasis surgery the overall survival was longer; an average overall survival was 87 months (median 58 months). 58% and 38% of patients survived respectively 5 and 10 years. Time between treatment of primary tumour (PT) and lung metastasis surgery (disease free interval DFI) was on average 4 years, median 41 months. The patients who showed DFI-longer than 2 years had tendency to live longer (p = 0.086). Patients with PM are recommended to be operated on, even if further PM occur.

Aims:To evaluate the efficacy of pulmonary metastasectomy in 93 patients with lung metastases (LM) operated on from 1983 to 1997.Methods:We assessed: location and histological diagnosis of the primary tumour (PT); the extent of pulmonary resection; and disease-free interval (DFI). Survival analysis was undertaken using the Kaplan–Meier method.Results:Surgical complications occurred in eight (9%) patients; two (3%) died in hospital; seven (8%) were operated again because of further LM. In the whole patient group the average survival after metastasectomy was 40 months (median 22 months). The actuarial survival was 44% at 3 years and 35% at 5 years. With metastasectomy we achieved an overall survival after treatment of PT of 87 months (median 58 months). The actuarial survival was 58% at 5 years and 38% at 10 years. The average time between the treatment of PT and metastasectomy DFI was 4 years (median 41 months). Patients with a DFI of more than 2 years tended to live longer (P=0.086). There were 23 patients with non-epithelial and 70 patients with epithelial tumours. Their DFIs were similar (mean 47, median 34 months for non-epithelial and mean 51, median 29 months for epithelial tumours). Of patients with non-epithelial tumours, 38% survived for 5 years and their survival curves were similar. In the group of tumours with the most frequent location, the results of metastasectomy did not differ considerably: 5 year survival rates of 20% for patients with kidney tumours, 28% for colorectal cancer, 30% for soft-tissue sarcoma, 28% for skin melanoma and 18% for breast cancer.Conclusions:Lung metastasectomy seems to be a safe and efficient method of treatment even for patients who show further metastases. According to our study it seems that, except for LM of breast carcinoma (which has a slightly worse prognosis), the results of surgical resection are not dependent on either the location or the histological pattern of the PT. For this reason patients indicated for operation can be selected according to similar criteria.

Lacrimal fluid plays a very significant role in maintaining proper functions of conjuctivas, cornea and eyelids. The fluid is secreted by the main lacrimal gland and additional glands. It produces the so called preocular lacrimal film. A number of clinical tests, such as Chirmer's tests I and II, break-up-time (BUT), lysozyme, and flow tests are used in quantitative and qualitative analyses, as well as in the determination of the lacrimal film stability. The aim of work was to utilize these in assessing the lacrimal secretion and the lacrimal film stability in workers chronically exposed to petroleum derivatives. Fifty three workers from departments of acetobenzene, benzene and butadiene, phenol and acetone, sewage waters, asphalt oxidas, polyethylene and polypropylene, were eligible for the study (group I). During previous examinations, acquired disorders in colour perception were diagnosed in all the subjects by means of the Mansuella-Fansworth 100-Hue test. The age range was 25 to 56 years, with a mediane of 44.1 years +/- 6.5. Mean duration of employment was 22 years (SD +/- 8.25). The control group (group II) was composed of 28 men aged between 24 and 60 years with a median of 42.7 years +/- 6.3, never employed under conditions of exposure to toxic chemicals. On the right eye of each subject Schirmer's test was performed after instilling into the conjunctival sac 1-2 drops of Alcain solution according to Whitcher. Five min following anesthesia of the conjunctival sac, a standardised belt of blotting-paper with colour dampness markers Vidisic (Dr Mann Pharma GMBH, Germany) was placed in the vicinity of the external angle of the eye. After 5 min the degree of the belt dampness was measured in millimetres. After 30 min the break-up-time test was performed on the left eye. Fluorescein was released to conjunctival sac from a sterile belt of blotting-paper (Haag-Strait Co.). A slit lamp with cobalt filter was used to calculate time (in sec) that elapsed between opening of the lid slit and the first symptom of breaking-up the lacrimal film. The results obtained were presented in the form of arithmetic means and standard deviation values +/- SD. Schirmer's test was 13.40 +/- 7.43 mm in group 1, and 22.54 +/- 8.25 mm in the control group, mean values differed significantly, p0.01. Lacrimal film break-up-time was 16.30 +/- 6.19 sec in group 1, and 31.48 +/- 7.96 sec in the control group, mean values differed significantly, p0.01. In persons chronically exposed to petroleum derivatives, statistically significant decrease in lacrimal secretion, as well as shortening of lacrimal film break-up-time were found when compared with the control group.

Most of the persistent organochlorine (OC) pesticides, excluding lindane, were banned in Poland in 1975/76. The first restrictions concerning the use and marketing of lindane (gamma-HCH) became effective in 1980 and were gradually extended until it's agricultural use was ultimately banned in 1989. Unfortunately, there are no detailed data on the use and release of PCBs to the environment in Poland. The former studies showed that in the late seventies the concentrations of OC pesticides and their metabolites in men reached considerable high levels. Despite of the restrictions or bans of these pesticides in most of the countries of the temperate climate, they still circulate in various food chains and eventually concentrate in man. Many authors claim an uneven distribution of the OC compounds in the population and report different levels in men and women and also some relations between OC compounds levels in fat tissues and age. Environmental contamination also plays an important role in the magnitude of OC compounds levels in man. The aim of this paper is to present the actual concentrations of HCB, p,p[prime]-DDT, p,p[prime]-DDE, isomers of HCH (alpha, beta, gamma), and PCBs in human adipose tissues particularly regarding age and sex as possible factors influencingmore » the levels of these compounds and to contribute to the general discussion on the distribution patterns of the organochlorine compounds in the population. 12 refs., 3 tabs.« less

The results of radical and partial surgical treatment of 146 patients with mediastinal tumors have been assessed. All patients were operated at the Specialistic Hospital in Zakopane from the 1st January, 1967 to the 31st December, 1989. Hundred twenty one patients (82.9%) suffered from malignancy and 25 (17.1%) from non-malignant mediastinal tumors. Mortality rate was 2.0%. Late results have been expressed in terms of survival period, and they have been as follows: 44.4% of patients survived 20 years after surgery, 36.5% of patients survived 15 years, 42.9% of patients--10 years, and 56.1% of patients survived 5 years. More than 50% of operated patients resumed their previous work.