CLINICAL AND EXPERIMENTAL MEDICAL LETTERS

DEAR DOCTOR,

Here is the November issue of the CLINICAL AND EXPERIMENTAL MEDICAL
LETTERS (Clin Exp Med Lett, 2010, 51, 2) now available online on our
Website at www.ceml-online.com [2]. Below you will find abstracts of
articles.

We hope, you will find the current issue interesting and valuable.
Should you have any comments on the presented articles, please do not
hesitate to share your opinion in the letter-to-the-editor sent to
iza.pranga@medscimonit.com [3].

JACEK RYSZ
Editor-in-Chief

MACIEJ BANACH
Deputy Editor

CLIN EXP LETT 2010, VOL.51, NO. 2

REVIEW PAPER

CUTANEOUS CHANGES AS A SYMPTOM OF EITHER HCV INFECTION OR THERAPY
COMPLICATION [4]

_Anna Wozniacka, Maciej Jablkowski _

The hepatitis type C virus (HCV) and chronic hepatic disease, which the
virus induces, are significant health problems of truly global
magnitude. According to WHO data, approximately 180 million people are
infected with HCV world-wide. The majority of patients, with either
acute or chronic infection, do not demonstrate evident clinical symptoms
of liver disease, while concomitant, non-specific extrahepatic symptoms
are fairly often observed, affecting joints, muscles, nervous system,
gastric tract or skin. An accurate, consolidated evaluation of observed
extrahepatic symptoms could become a valuable diagnostic indication,
decisive for the accurate diagnosis of HCV infection.
This paper presents the pathogenesis, epidemiology and the clinical
picture of HCV infection, with particular consideration of cutaneous
changes, which may either accompany HCV or be an adverse effect of
combined therapy with interferon alpha and ribavirin.

RESEARCH PAPER

DEPRESSION AND ISCHEMIC HEART DISEASE [5]

_Agnieszka Stetkiewicz-Lewandowicz, Jan Goch, Alina Borkowska _

Depressive disorders are regarded as risk factors for ischemic heart
disease. They may be also factors that play a role in pathogenesis of
Ischemic Heart Disease (IHD).
The study screened a population of patients hospitalized in the
Cardiology Department of the Medical University in Lodz due to different
forms of IHD. The study group consisted of 111 patients (89 men, 22
women) whose mental status was assessed by means of Beck Depression
Inventory (BDI) and Hamilton Depression Rating Scale (HDRS).
Physicians should pay more attention on depressive symptoms in patients
with IHD as they may need close follow-up and monitoring of their mood,
with initiation of treatment for depression if symptoms persist.

SERUM ADIPONECTIN, LEPTIN AND SOLUBLE LEPTIN RECEPTOR CONCENTRATIONS
AFTER ACUTE CORONARY SYNDROME IN MALES, ATTENDANTS OF EARLY CARDIAC
REHABILITATION [6]

_Barbara Kopff, Katarzyna Szmigielska, Michał Chwałkiewicz, Anna
Jegier _

Adiponectin, leptin, and soluble leptin receptor (sObR) have important
effect on atherosclerosis and its complications – coronary artery
disease and acute coronary syndrome (ACS). In patients recovering after
acute coronary syndrome these adipokines have not been studied until
now.
The subjects were 38 males, participants of 8 weeks early cardiac
rehabilitation (ECR), started up to 30 days after percutaneous coronary
intervention (PCI) for ACS. At admission and on final of the ECR every
subject underwent anthropometric measurements, submaximal exercise test,
and answered 24-hour dietary questionnaire. Venous blood samples were
collected for adiponectin, leptin, and sObR serum concentrations and
lipid profiles assessment.
In male patients after ACS and primary PCI, attending ECR the sObR
serum concentrations increased, presumably reflecting the decrease of
leptin resistance. It should be considered a positive sign, possibly
preceding other beneficial metabolic changes.

COMPARISON OF THE PRECISION IN DETERMINATION OF HUMAN SPERM
CONCENTRATION BETWEEN AN IMPROVED NEUBAUER HAEMATOCYTOMETER AND MAKLER
COUNTING CHAMBER [7]

_Katarzyna Marchlewska, Eliza Filipiak, Elżbieta Oszukowska, Renata
Walczak-Jędrzejowska, Krzysztof Kula, Jolanta Słowikowska-Hilczer _

One of the most difficult parts of semen analysis is the evaluation of
sperm concentration. One aspect of quality assurance is selection and
validation of appropriate techniques and equipment.
The comparison of two methods of sperm concentration analysis was
performed using an improved Neubauer haemocytometer and Makler counting
chamber. The study population consisted of 100 men recruited from
seminal laboratory patients.
The results indicate that the Neubauer haematocytometer is more precise
diagnostic tool for the evaluation of spermatozoa concentration in
comparison to the Makler counting chamber. Although less complicated,
assessment of sperm count by the Makler chamber is an inaccurate method
when semen samples from patients with oligozoospermia are concerned.

STUDY OF HEART RATE AUTONOMIC MODULATION IN PATIENTS WITH ASTHMA
DISEASE [8]

_Victor Souza, Ivan Costa, Audrey Borghi Silva, Diego Lacerda, Dirceu
Costa, Claudia Oliveira, Vera Lucia Santos Alves, Roberto Stirbulov,
Luis Vicente Franco de Oliveira, Luciana Malosa Sampaio _

Evaluate the autonomic activity of patients with asthma in moderate
supine and sitting positions.
Twenty individuals with asthma and 10 healthy individuals were studied.
Heart rate and electrocardiographic R-R intervals (iR-R) were recorded
for 360 seconds in the supine and seated positions. Heart rate
variability was analyzed in the time domain (TD) (RMSSD index, ie, the
root mean square of the squares of the differences between successive
iR-R records; and the SDNN index, ie, the mean standard deviation of
normal iR-R in ms) and in the frequency domain (FD), from the
low-frequency (LF) and high-frequency (HF) bands in absolute units (au)
and normalized units (nu), and the LF/HF ratio.
Patients with asthma present reduced HRV when compared with healthy
sex- and age-matched controls, with the reduction in sympathetic and
vagal activity. Furthermore, both patients and healthy individuals with
asthma do not present autonomic adjustments with front postural change.
Future studies should examine the HRV as a useful tool to obtain
parameters for the stratification of cardiovascular risk in this
population, and in the evaluation of different physical therapy
interventions designed to treat these patients.

EVALUATION OF LUMBAR SYMPATHECTOMY IMPACT ON THE CLINICAL COURSE, BLOOD
FLOW PARAMETERS AND MUSCLE PERFUSION IN A GROUP OF PATIENTS WITH
PERIPHERAL ARTERIAL DISEASE (PAD) [9]

_Tomasz Lesiak, Jacek Mikosiński, Łukasz Piskorz, Wiesław
Tryniszewski, Zbigniew Maziarz, Marian Brocki, Jacek Rysz _

Occlusive arterial disease is a common disease. Frequently, at the time
of diagnosis, disease severity prevents revascularization. The study
evaluated lumbar sympathectomy influence on the clinical course, blood
flow parameters and muscle perfusion.
Research group included 33 patients (13 women – 39.4%, and 20 men –
60.6%) aged from 47 to 81 (mean age 63.54±8.63 years) treated for PAD
and qualified to undergo lumbar sympathectomy. Physical examination,
standard vascular tests (ankle-brachial, thigh-ankle and thigh-shin
indices, maximum flow velocity, PI and RI in selected arteries),
perfusion scintigraphy of lower limbs muscles at rest and on exertion
were carried out before and 6 months after surgery.
Lumbar sympathectomy in patients suffering from severe, atherosclerotic
lower limb ischaemia brought positive effects such as increasing walking
distance, decreasing rest pain or healing skin ulcers. This effect was
not combined with improvement of muscle blood perfusion but with
increase of pain treshhold (walking distance, rest pain) and skin blood
flow (ulcer healing).

EVALUATION OF COMBINED, CONSERVATIVE TREATMENT IMPACT ON THE CLINICAL
COURSE, BLOOD FLOW PARAMETERS AND MUSCLE PERFUSSION IN THE GROUP OF
PATIENTS WITH NEWLY DIAGNOSED, UNTREATED PERIPHERAL ARTERIAL DISEASE
(PAD) [10]

_Tomasz Lesiak, Jacek Mikosinski, Łukasz Piskorz, Wiesław
Tryniszewski, Zbigniew Maziarz, Marian Brocki, Jacek Rysz _

Epidemiological studies determined incidence of obliterative
atherosclerosis as ranging between 2.45–10%. The course of disease is
often asymptomatic and demonstration of symptoms occurs when vascular
lesions are significantly advanced. This article discusses conservative
treatment of patients with PAD whose key complaint was intermittent
claudication. The Authors proposed multi-stage treatment regimen of this
disease including lifestyle modification, treatment of comorbid
disorders, and pharmacotherapy (aspirin, pentoxifylline, buflomedil,
L-arginine). The study evaluated influence of 6-month treatment on
clinical course, blood flow parameters as well as muscle perfusion.
The participants included 35 patients (14 women – 40.0%, and 21 men
– 60.0%) aged from 49 to 80 (mean age 68.37±10.25 years) first time
in life diagnosed with PAD. Physical examination, standard vascular
tests (ankle-brachial, thigh-ankle and thigh-shin indices, maximum flow
velocity, PI and RI in selected arteries), perfusion scintigraphy of
lower limbs muscles at rest and on exertion were carried out before and
after 6 months of treatment.
Combined medical treatment brought on positive effect on patients
suffering from recently diagnosed, thus not yet treated atherosclerotic
lower limb ischaemia of IIA and IIB stages according to Fontaine’s
scale.

HEART RATE VARIABILITY INDICES IN PATIENTS WITH CORONARY HEART DISEASE
AFTER SHORT-TERM AND LONG-TERM OUTPATIENT CARDIAC REHABILITATION [11]

_Katarzyna Szmigielska, Anna Jegier _

The aim of this study was to evaluate the influence of regular physical
activity on heart rate variability indices (HRV) in men with coronary
heart disease.
We studied 105 patients with coronary heart disease. Group 1 consisted
of 42 participants in an 8-week early, ambulatory cardiac rehabilitation
program (ACR). Group 2 consisted of 32 patients who had been
participating in phase III ACR for a mean period of 7 years. Group 3
consisted of 31 sedentary patients who had no medical contraindications
for physical activity. Time and frequency parameters were estimated from
a short-term HRV procedure.
Heart rate variability indices in patients with coronary heart disease
are positively modified after phase II rehabilitation. Regular,
appropriate physical training, continued for several years in cardiac
rehabilitation phase III, leads to more profound adaptive changes.

MUCUS SOLUBILITY BEHAVIOR IN CYSTIC FIBROSIS PATIENTS MONITORED BY
PHOTOACOUSTIC TECHNIQUE [12]

_Cristiane Coelho, Paulo Barja, Evanirso Aquino, Marcelo Barboza,
Fernanda Gonzaga, Cinara de Mattos, Luiz de Mattos, Newton Faria Junior,
Luciana Sampaio, Luis Oliveira _

Cystic fibrosis is the most common autosomal recessive disorder caused
by mutations, which results in aberrant ion transport across the
respiratory epithelium, leading to a complex pathophysiology of
mucociliary function. The disease is characterized by retention of thick
and viscid mucus that is subsequently invaded by bacterial pathogens,
particularly Staphylococcus aureus and Pseudomonas aeruginosa. The
primary objective of this study was to assess the evaluation of mucus
solubility behavior in cystic fibrosis patients with different bacterial
colonization.
A total of 26 samples of bronchial secretions were analyzed. They were
divided in 3 groups according to the sputum culture analysis: GI without
colonization, GII colonized by Staphylococcus aureus, and GIII colonized
by Pseudomonas aeruginosa. The evaluation of mucus solubility behavior
was accomplished using the photoacoustic technique. The photoacoustic
signal results from the conversion of amplitude modulated
electromagnetic energy to modulated thermal energy through
non-radioactive decays in the absorbing material sample.
This measurement approach provided unique information indicating the
photoacoustic technique can be successfully employed in the analysis of
the solubilization processes.

EVALUATION OF FUNCTIONALITY IN HEMIPARETIC PATIENTS AFTER BALANCE
TRAINING WITH THE WII FIT PROGRAM [13]

_Luciana Barcala, Fernanda Colella Colella, Aline Rosa, Josilene Brito,
Mayara Inouye, Claudia Oliveira _

To evaluate functionality in hemiparetic patients after therapy
combined with balance training using the Wii Fit program, and compare it
with conventional physiotherapy.
Twelve post-stroke hemiparetic patients were divided into 2 groups,
each with a different method of intervention. Patients were evaluated
for their functionality in balance, mobility and daily activities before
and after treatment.
This study shows that using a new technique, such as balance training
with Wii Fit, shows positive results in the acquisition of functionality
in hemiparetic patients, and thus physiotherapy may adopt an additional
type of resource to aid patients in rehabilitation.

CASE REPORT

THE RARE COEXISTENCE OF JOB’S SYNDROME AND ALLERGY TO COMMON
ALLERGENS AND A SHORT STATURE IN POLISH SIBS [14]

_Marek Mikołajczyk, Piotr Sturlis, Zbigniew Baj _

Hyperimmunoglobulin E syndrome is a rare, primary, immunodeficiency
disorder characterized by recurrent bacterial infections in presence of
high serum IgE level and eczema.
We report 2 siblings with HIES coexistent with allergy to common
allergens. The boy presents all symptoms and short stature. The girl,
with an incomplete picture of the syndrome has a normal stature. Besides
antibiotics, the children had the anti-allergic treatment. Since 2004,
we have observed a rarer hospitalization rate and need for intensive
antibacterial treatment.
Our results suggest need for complementary anti-allergic treatment in
HIES children.

DYSTHYMIA AS A MASK OF CELIAC DISEASE [15]

_Maja Tylińska, Marlena Broncel _

Celiac disease is a immunologically-based inflammatory enteropathy of
the small intestine caused by gluten intolerance. Reduced prevalence of
classic form of celiac disease is observed lately, but accompanied by
increasing rate or atypical forms, developing in older children and
adults.
The paper presents the case of celiac disease in a 32-year-old male
patient, displaying symptoms of digestive system disorders and dysthymia
and treated for functional dyspepsy. The diagnostic process was
exceptionally long-lasting and arduous for the patient because of
persistence of symptoms. An in-depth history, physical examination and
laboratory tests made it possible to establish the final diagnosis of
celiac disease accompanied by Durhing disease and dysthymic disorder.
Published reports indicate that celiac disease is an under-diagnosed
condition, and sensitivity of the diagnostic process could be altered if
determination of antibodies was introduced to the panel of tests ordered
by general practitioners. The role of early introduction of gluten-free
diet should be stressed. The diet allows prevention of development of
serious complications and improves patients’ quality of life.

RETROPERITONEAL GANGLIONEUROMA IN A YOUNG BODYBUILDER [16]

_Adam Durczyński, Stanisław Sporny, Dariusz Szymański, Piotr
Hogendorf, Janusz Strzelczyk _

Anabolic steroid intake is common among bodybuilders, although it is
associated with a number of adverse effects, including tumorgenesis.
We describe the case of 24-year-old male athletic bodybuilder (weight
110 kg, height 179, BMI 34 kg/m2) admitted to our department with
diffused, intermittent, abdominal pain of 4 months duration. The patient
had a history of long-term abuse of large doses of anabolic steroids of
unknown origin. Computed tomography scans revealed a large, 140×100 mm,
well-demarcated tumor, located between the left kidney, pancreas and
spleen, presumably originating from the left kidney or adrenal gland.
The tumor was proven to be hormonally inactive. Retroperitoneal tumor
excision was performed with surrounding organs left intact. A final
histopatologic examination revealed a well-differentiated 16cm
ganglioneuroma. Despite the rarity of its occurrence, ganglioneuromas
must be considered in the differential diagnosis of retroperitoneal
tumors.
This unique finding raises questions concerning potential development
of ganglioneuroma secondary to steroid abuse among bodybuilders.
Bodybuilders should be made aware of the serious medical risks of
steroid abuse.

© Clinical and Experimental Medical Letters 2010

Links:
------
[1] http://www.ceml-online.com/news/l_12_2010.htm
[2] http://www.ceml-online.com
[3] mailto:iza.pranga@medscimonit.com
[4] http://www.ceml-online.com/index.php?/archives/article/881274
[5] http://www.ceml-online.com/index.php?/archives/article/881252
[6] http://www.ceml-online.com/index.php?/archives/article/881253
[7] http://www.ceml-online.com/index.php?/archives/article/881257
[8] http://www.ceml-online.com/index.php?/archives/article/881264
[9] http://www.ceml-online.com/index.php?/archives/article/881265
[10] http://www.ceml-online.com/index.php?/archives/article/881266
[11] http://www.ceml-online.com/index.php?/archives/article/881271
[12] http://www.ceml-online.com/index.php?/archives/article/881302
[13] http://www.ceml-online.com/index.php?/archives/article/881304
[14] http://www.ceml-online.com/index.php?/archives/article/881263
[15] http://www.ceml-online.com/index.php?/archives/article/881267
[16] http://www.ceml-online.com/index.php?/archives/article/881303