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We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment.

The aim of this study was to investigate the association between metabolic syndrome and liver enzymes in overweight and obese adolescents and young adults.A total of 126 overweight and obese adolescents and young adults (age, 15-26 years), 55 (43.6%) with metabolic syndrome and 71 (56.4%) without metabolic syndrome, were studied.Patients with metabolic syndrome had significantly higher alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP) levels compared to patients without metabolic syndrome [36.5±22.2 vs. 29.4±17.8 IU/L (P=0.043), 33.8±17.8 vs. 26.9±18.4 IU/L (P=0.002), and 84.3±32.2 vs. 75.7±29.5 IU/L (P=0.063)]. Aspartate aminotransferase (AST) levels were similar in both groups (24.1±9.8 vs. 23.3±9.0 IU/L, P=0.674). Elevated AST, ALT, GGT, and ALP levels were observed in 6, 15, 18, and 5 patients (11%, 27%, 14%, and 9%) with metabolic syndrome compared to 6, 17, 6, and 4 (8%, 24%, 8% and 5%) patients without metabolic syndrome (P=0.872, P=0.826, P0.001, and P=0.035). In multivariate regression models adjusted for age and gender, metabolic syndrome was not a significant predictor of ALT (P=0.967), GGT (P=0.526), and ALP levels (P=0.221), but insulin resistance was a significant predictor for ALT and GGT levels (P=0.001, P=0.028).Changes in liver function tests were observed in obese patients with metabolic syndrome, compared to patients without metabolic syndrome, especially in ALT and GGT levels. Insulin resistance is an independent pathogenic mechanism in liver function test changes regardless of metabolic syndrome in nondiabetic centrally obese youth.

Liberase HI has many advantages over traditional collagenases. Liberase performs the rapid dissociation of human pancreata and allows for the preservation of the morphological and functional integrity of isolated islets. The aim of this study was to investigate the effect of different concentrations of Liberase HI (1.5, 2.5 and 3.5 mg/ml) on the yield, viability and function of islets isolated by a non-automated method. Based on our results, the Liberase HI concentration 1.5 mg/ml is recommended for this method of isolation. .

BACKGROUND/AIM The most effective method for human adult pancreatic islets purification is density-gradient centrifugation. The aim of this study was to analyze the effects of non-automated purification on preservation of functional capacity of human adult pancreatic islet cells. METHODS Human pancreata were obtained after pancreatectomy in the patients with chronic pancreatitis or benign tumors. Pancreatic islets were purified by non-automated method in discontinuous Ficoll density gradient. The samples were divided in 2 fractions: purified (P) and non-purified (NP) cultures. Islets were stained with diphenyl-thiocarbazone. The efficiency of separation was determined by comparing percentage of stained cells in P and NP cultures on day 1, 3 and 7 of shortterm cultivation. Glucose-stimulated insulin secretion was expressed as stimulation index (SI). RESULTS The results obtained showed a statistically significant difference (p < 0.01) between P and NP cultures. P cultures had higher percentages of stained cells (70.43 +/- 3.97%, 73.77 +/- 4.22% and 71.34 +/- 4.69% on the first, third and seventh day of cultivation, respectively) than NP cultures (53.68 +/- 1.71%, 57.14 +/- 3.94% and 43.97 +/- 4.56%, respectively). P cultures had higher values of SI for the first, third and seventh day of cultivation than NP cultures (0.45 +/- 0.08, 0.80 +/- 0.21, 1.28 +/- 0.15 and 0.46 +/- 0.10, 0.752 +/- .0.16, 0.76 +/- 0.11 for P and NP cultures respectively). The difference was statistically significant on day seven (p = 0.01). CONCLUSION Although during purification process islets were exposed to a number of insults that might result in cellular damage and functional impairment, our assessments showed that islets in P cultures preserved their functional capacity better than islets in NP cultures, since they had greater insulin secretion.

We investigated the influence of short-term culture in vitro on the appearance of apoptosis of human fetal pancreatic islets (HFIs) and its effect on the mass and insulin-secretory capacity (ISC) of ?-cells. It was found that apoptosis was present from the end of the culture period, increasing as a function of time and leading to decrease of ?-cell mass. At the same time, ISC decreased. The decrease of ?-cell mass and ISC may influence significantly the clinical outcome of HFIs transplantation in type 1 diabetic patients.

Cilj naše studije bio je odrediti međusobne odnose između „prve", neenzim-ske, te „druge", enzimske crte antioksidacijske zaštite u bolesnika s šećernom bolesti tipa 2 i očitovanim kardiovaskularnim komplikacijama. Drugi je cilj bio utvrditi odnose između prooksidacijskih (lipidni status) i antioksidacijskih parametara u ispitivanih bolesnika. Materijali i metode: U našu je studiju parova bilo uključeno ukupno 117 bolesnika s šećernom bolesti tipa (69 sa, te 48 bez kardiovaskularnih komplikacija) i 42 zdrava ispitanika. Određivani su sljedeći antioksidacijski enzimski parametri: eritrociti, Cu, Zn-SOD, glutation-peroksidaza (GPx) i glutation-reduk-taza (GR), kao i ukupni antioksidacijski status (engl. total antioxidant status, TAS), te bilirubin, mokraćna kiselina, ukupni proteini, albumin i haptoglobin. Enzimski antioksidacijski parametri i TAS analizirani su pomoću komercijalnih testova tvrtke RandoxLtd, V. Britanija, koji se temelje na spektrofotometrij-skim metodama, dok su ostali neenzimski i lipidni parametri određeni standardnim laboratorijskim metodama. Rezultati: U odnosu na zdrave ispitanike, bolesnici s šećernom bolesti tipa 2 i kardiovaskularnim komplikacijama imali su značajno niže vrijednosti en-zimskih antioksidansa (P < 0,001) i više vrijednosti ukupnog bilirubina (P = 0,050), mokraćne kiseline (P < 0,001) i haptoglobina (P < 0,001). Slaba je pozitivna korelacija utvrđena između SOD i GPx (R = 0,289, P = 0,028) te između SOD i GR (R = 0,259, P = 0,045), a slaba negativna korelacija zabilježena je između GPx i mokraćne kiseline (R = - 0,35, P = 0,009) te GPx i ukupnog bilirubina (R = - 0,40, P = 0,018). TAS je slabo korelirao s trigliceridima (R = 0,32, P = 0,037), a GPx i GR su korelirali s HDL-kolesterolom (R = 0,457, P = 0,007; te R = 0,466, P = 0,001). Zaključci: Temeljem dobivenih rezultata može se zaključiti da bolesnici s šećernom bolesti tipa 2 imaju značajno promijenjenu antioksidacijsku zaštitu, uz različiti stupanj neravnoteže između skupa neenzimskih tvari i aktivnosti enzimskih antioksidanasa, koja ovisi o tome jesu li se kardiovaskularne komplikacije pojavile ili ne., The objective of our study was to determine the interrelations between the "first", non-enzymatic, and the "second", enzymatic line of antioxidant defense in patients with type 2 diabetes mellitus and manifested cardiovascular complications. The second aim was to determine the relations between pro-oxidant (lipid status) and antioxidant parameters in patients under observation. Methods: In our case-control study, a total of 117 type 2 diabetic patients (69 with and 48 without cardiovascular complications) and 42 healthy subjects were included. Antioxidant enzymatic parameters: erythrocyte, Cu,Zn-SOD, glutathione peroxidase (GPx) and glutathione reductase (GR), as well as total antioxidant status (TAS), bilirubin, uric acid, total proteins, albumin and haptoglobin were determined. The enzymatic antioxidant parameters and TAS were analyzed using commercial tests manufactured by Randox Ltd. UK, based on spectrophotometer methods, while the other non-enzymatic and lipid parameters were determined by standard laboratory methods. Results: In relation to healthy subjects, type 2 diabetics with cardiovascular complications had significantly lower values of enzymatic antioxidants (P < 0.001), and higher values of total bilirubin (P = 0.050), uric acid (P < 0.001) and haptoglobin (P < 0.001). Weak positive correlation was found between SOD and GPx (R = 0.289, P = 0.028) and between SOD and GR (R = 0.259, P = 0.045), while weak negative correlation was obtained between GPx and uric acid (R = -0.35, P = 0.009), GPx and total bilirubine (R = -0.40, P = 0.018). TAS correlated weakly with triglycerides (R = 0.32, P = 0.037), while GPx and GR correlated with HDL-cholesterol (R = 0.457, P = 0.007; and R = 0.466, P = 0.001). Conclusions: Based on the obtained results, it may be concluded that type 2 diabetic patients have significantly modified antioxidant defense, with a varying degree of imbalance between the "pool" of non-enzymatic substances and the activity of enzymatic antioxidants, which depends on whether they have or not manifested cardiovascular complications.

Summary: Oxidative stress and hyperglycemia play an important role in the aethiology of vascular complications in diabetes. Hyperglycemia induces a large number of alterations in vascular tissue that potentially accelerate the atherosclerotic process. Nonenzymatic glycosylation of proteins and lipids which can interfere with their normal function by disrupting molecular conformation, alter enzymatic activity, reduce degradative capacity and interfere with receptor recognition, oxidative stress and protein kinase C activations are the major processes that encompass most of the pathological alterations in the diabetic vasculature. Diabetes-associated oxidative stress is a consequence of both increased production of free radicals and reduced capacity for antioxidative defense. The aim of this study was to test the parameters of antioxidative defense: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione reductase (GR) and total antioxidant status (TAS), in type 2 diabetic patients with and without cardiovascular complications in order to determine the effect of hyperglycemia on the extent of disorders of antioxidative parameters. Sixty nine type 2 diabetic patients with cardiovascular complications, along with 48 diabetics without complications and 42 healthy subjects were examined. Determination of antioxidant parameters was performed using commercial tests manufactured by Randox Laboratories, UK, based on spectrophotometer determination methods. Statistical data processing revealed significantly lower SOD, GSH-Px, GR and TAS values in type 2 diabetic patients with cardiovascular complications in comparison to the control group (p

OBJECTIVE—To investigate the role of dietary factors in the development of type 2 diabetes. RESEARCH DESIGN AND METHODS—In the context of the Multinational MGSD Nutrition Study, three groups of subjects were studied: 204 subjects with recently diagnosed diabetes (RDM), 42 subjects with undiagnosed diabetes (UDM) (American Diabetes Association criteria—fasting plasma glucose [FPG] ≥126 mg/dl), and 55 subjects with impaired fasting glucose (IFG) (FPG ≥110 and RESULTS—Compared with control subjects, RDM more frequently had a family history of diabetes (49.0 vs. 14.2%; P < 0.001), exercised less (exercise index 53.5 vs. 64.4; P < 0.01), and more frequently had sedentary professions (47.5 vs. 27.4%; P < 0.001). Carbohydrates contributed less to their energy intake (53.5 vs. 55.1%; P < 0.05), whereas total fat (30.2 ± 0.5 vs. 27.8 ± 0.5%; P < 0.001) and animal fat (12.2 ± 0.3 vs. 10.8 ± 0.3%; P < 0.01) contributed more and the plant-to-animal fat ratio was lower (1.5 ± 0.1 vs. 1.8 ± 0.1; P < 0.01). UDM more frequently had a family history of diabetes (38.1 vs. 19.0%; P < 0.05) and sedentary professions (58.5 vs. 34.1%; P < 0.05), carbohydrates contributed less to their energy intake (47.6 ± 1.7 vs. 52.8 ± 1.4%; P < 0.05), total fat (34.7 ± 1.5 vs. 30.4 ± 1.2%; P < 0.05) and animal fat (14.2 ± 0.9 vs. 10.6 ± 0.7%; P < 0.05) contributed more, and the plant-to-animal fat ratio was lower (1.6 ± 0.2 vs. 2.3 ± 0.4; P < 0.05). IFG differed only in the prevalence of family history of diabetes (32.7 vs. 16.4%; P < 0.05). CONCLUSIONS—Our data support the view that increased animal fat intake is associated with the presence of diabetes.

Starting from the evidence-based health benefits that resistant starch (RS) shows when added to the diet, our aim in this study was to evaluate the effects of increased fibre intake with two different levels of RS coming from regular daily consumed foods on normalization of glycaemia within lifestyle intervention in the population with risk factors for developing diabetes. Study included 47 overweight and obese men and women with disordered glucoregulation and dyslipidaemia, aged between 45-74, divided into RS and Fibre group. Participants were subjected to the lifestyle and dietary intervention with low-fat and high-fibre (> 25 g/day) diet for 12 months and were offered two different dietary advices aimed at increasing total fibre intake in Fibre group and at increasing RS intake in RS group. The intake of macronutrients and total fibre was similar between groups at the end of the study, but achieved RS intake was two times higher in the RS group. Decrease in total cholesterol and non-HDL-cholesterol was more pronounced in RS group in comparison with Fibre group (p = 0.010, p = 0.031, respectively), whereas in Fibre group, a more pronounced effect on glucoregulation was observed: significant fall in glycaemia after 2-h oral glucose tolerance test (7.93 vs 6.96 mmol/L, p = 0.034). At the end of the study, RS-rich diet failed to affect glycaemic control in prediabetic obese individuals in contrast to the regular fibre-rich diet, which indicated that fibre profile could be an important determinant of the effect of dietary intervention.

In this study we compared the effects of duration of cold ischemia (longer and shorter ischemia) on the yield, viability and preservation of the physiological function and insulin secretion of adult human pancreatic islets in short-term (seven days) culture. Based on the tested parameters, we established that there are no major differences between these two test groups and that the storage and transport of pancreatic tissue in physiological solution at 4oC gives quite satisfactory results.

Background/Aim. During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED. Methods. The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbA1c) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded. Results. Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26?1.49 points) compared with the medium improvement in the group 1 (6.27?1.35 points). After three months HbA1c values decreased for 2.26?1.62 (p < 0.001). Conclusion. Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients. .

Background: The aim of this study was to examine prothrombogenic factors and antioxidative defense in obese children and adolescents with pre-metabolic and metabolic syndrome, and to analyze insulin secretion and resistance, early glycoregulation disorders and lipid status. Methods: Insulin sensitivity was determined using the homeostasis model assessment for insulin resistance (HOMA-IR), while insulin secretion was determined using the homeostasis model assessment (HOMA-β). Prothrombogenic factors analyzed were plasma plasminogen activator inhibitor-1 (PAI-1) and fibrinogen. Superoxide dismutase and glutathione peroxidase were measured as markers of antioxidative defense. Results: Patients with metabolic syndrome were characterized with increased body mass index (BMI), waist circumference, and HOMA-IR and HOMA-β levels, and all had increased blood pressure and triglyceride levels, low high-density lipoprotein cholesterol levels, increased PAI-1 levels and reduced antioxidative defense levels. Patients with pre-metabolic syndrome had higher levels of basal and mean insulinemia during an oral glucose tolerance test, higher levels of HOMA-β and lower levels of antioxidative defense compared to patients with metabolic syndrome. Conclusions: Negative correlations between antioxidative defense parameters and BMI, abdominal obesity, insulin secretion, systolic blood pressure and atherogenic lipid factors, as well as correlations between PAI-1 and insulin resistance and basal glycemia in the metabolic syndrome group contribute to accelerated atherosclerosis. Positive correlations between PAI-1 and waist circumference and BMI, and negative correlations between BMI and antioxidative defense in the pre-metabolic syndrome patients show that this early stage preceding the metabolic syndrome is also characterized by atherosclerotic complication risks and evident hyperinsulinism and insulin resistance.

To determine: (a) whether the components of metabolic syndrome (MetS) cluster more frequently than predicted by chance alone and (b) whether increased risk for MetS is associated also with values of each component below, but close to the cutoff points defining MetS.Anthropometrical and biochemical measurements were performed and a dietary questionnaire was filled-in in 1833 randomly selected non-diabetic subjects, 916 men and 917 women, 20-74 years old, in nine centres in five Mediterranean countries. The prevalence of MetS and of possible combinations of its individual components was measured. The expected frequencies of the above combinations were calculated according to the mathematical formula of probabilities.The overall prevalence of MetS was 27.2%, but varied greatly among countries, from 5.8% in Algeria to 37.3% in Greece. The observed prevalence of each combination diagnostic of MetS was higher than the expected by chance. Thus, the observed overall prevalence of MetS was also higher than the expected, 27.2 vs 24.0%, P=0.03. Furthermore, for each individual component (except high-density lipoprotein), as values in the normal range, approached the cutoff point, the risk of having MetS (i.e. clustering of the other components) increased significantly (odds ratio 2.2-4.6, P0.001).The MetS is not related to the Mediterranean type of diet and its prevalence varies greatly among five Mediterranean countries. The clustering of the components defining the MetS is not due to chance and moreover even 'high normal' levels of each component confer increased risk for the syndrome.