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IntroductionGhrelin, leptin and insulin are involved in neurohormonal regulation of energetic homeostasis.AimWe investigated the correlation between nutritional status and plasma levels of leptin, ghrelin and insulin in lean, obese and anorexic subjects.Material and methodsNineteen obese and 18 anorexic adults were enrolled in the study. Seventeen adults with normal body mass index (BMI) served as controls. Blood samples were taken twice: before breakfast and 2 h after breakfast. Fasting and postprandial ghrelin, leptin and insulin were examined. The following correlations were estimated: between BMI and basal level of tested hormones, between insulin and ghrelin, and between insulin and leptin. The threshold level of significance was p ≤ 0.05 for all calculations.ResultsBasal insulin level was lowest in anorexic patients and greatest in obese subjects. Fasting plasma ghrelin was lower in obesity and higher in anorexia as compared with the controls. Comparing with controls, fasting leptin levels were higher in obese and lower in anorexic subjects. There was positive correlation between BMI and basal leptin level in obesity. A significant postprandial increase was noted for insulin in all studied groups. Increased leptin and decreased ghrelin levels were detected 2 h after a meal in the control group. In obese patients, postprandial leptin was lower than before food intake, and fasting leptin showed positive correlation with basal insulin level.ConclusionsBasal plasma ghrelin, leptin and insulin levels differ according to nutritional status. Impaired ghrelin and leptin secretion and insulin sensitivity may be involved in the pathogenesis of eating disorders.

IntroductionAortic valve replacement (AVR) is the gold standard in treating symptomatic aortic valve defects. To improve the healing process and limit the trauma, the minimally invasive approach was introduced.AimTo compare the peri- and post-operative results of aortic valve replacement performed via conventional full sternotomy (con-AVR) and of AVR performed via partial upper sternotomy (mini-AVR).Material and methodsThe total study population was divided into 2 demographically homogeneous groups: mini-AVR (n = 74) and con-AVR (n = 76). There were no statistically significant differences in preoperative echocardiography.ResultsAortic cross-clamp time and cardiopulmonary bypass time were significantly longer in the mini-AVR group. Shorter mechanical ventilation time, hospital stay and lower postoperative drainage were observed in the mini-AVR group (p < 0.05). Biological prostheses were more frequently implanted in the mini-AVR group (p < 0.05). Patients from the mini-AVR group reported less postoperative pain. No significant differences were found in the diameter of the implanted aortic prosthesis, the amount of inotropic agents and painkillers, postoperative left ventricular ejection fraction (LVEF), medium and maximum transvalvular gradient or the number of transfused blood units. There were no differences in the frequency of postoperative complications such as mortality, stroke, atrial fibrillation, renal failure, wound infection, sternal instability, or the need for rethoracotomy.ConclusionsMinisternotomy for AVR is a safe method and does not increase morbidity and mortality. It significantly reduces post-operative blood loss and shortens hospital stay. Ministernotomy can be successfully used as an alternative method to sternotomy.

A b s t r a c tAllergic diseases are very common in developed countries, particularly among children, adolescents and young adults. Currently, allergies are being considered as an epidemic of the 21 st century. According to the Polish Society of Allergology, the percentage of adults suffering from asthma in our country is 5.4%, and in children 10%. The authors describe current knowledge regarding the pathomechanism, incidence, epidemiology and diagnostics of the most common significant allergic diseases, including allergic rhinitis, asthma, allergic conjunctivitis, atopic dermatitis and urticaria. One of the most common allergic diseases is allergic rhinitis, which is the result of an allergic inflammation of the nasal mucosa mediated by immunoglobulin E. Asthma is a lifelong chronic inflammatory disorder of the airways associated with a variety of structural changes occurring in children and adults of all ages. This disease is characterized by bronchial hyperreactivity and obstruction which often disappear either spontaneously or with treatment. Atopic dermatitis is a chronic and relapsing inflammatory skin disease with a varying clinical spectrum, and may often play the role of the first stage of the atopic march. Urticaria is a heterogeneous group of diseases, characterized by the presence of wheals and/or angioedema. The mainstay of allergy diagnosis is in vivo and in vitro testing. In vivo testing includes skin prick tests, prick-by-prick tests, atopy patch tests and also skin application skin test. In vitro testing includes measurement of serum total and antigen-specific IgE using various methods. During the last years, also component-resolved diagnostics have gained growing importance as a useful tool in clinical investigation of IgE-mediated allergies.K Ke ey y w wo or rd ds s: : allergy, allergic diseases, epidemic.

BackgroundThe prognosis in hypothermic cardiac arrest is frequently good despite prolonged period of hypoperfusion and cardiopulmonary resuscitation. Apart from protective effect of hypothermia itself established protocols of treatment and novel rewarming techniques may influence on outcome.The purpose of the study was to assess the outcome of patients with hypothermic circulatory arrest treated by means of arterio-venous extracorporeal membrane oxygenation (ECMO) according to locally elaborated protocol in Severe Accidental Hypothermia Center in Cracow, Poland.MethodsProspective observational case-series study – all patients with confirmed hypothermic cardiac arrest consulted with hypothermia coordinator were accepted for extracorporeal rewarming, unless contraindications for ECMO were observed (active bleeding).ResultsThe study population consisted of 10 patients (7 male, median age 48.5 years). The core temperature measured esophageally was 16.9–28.4 °C, median 22 °C. On admission 5 patients presented with asystole and 5 with ventricular fibrillation. Duration of circulatory arrest before ECMO implantation was 107 to 345 min (median 156 min). The duration of ECMO support was 1.5 to 91 h (median 22 h). Cardiorespiratory stability and full neurologic recovery was achieved in 7 patients. The duration of mechanical ventilation was 88–437 h (median 177 h) and the length of stay in the ICU was 8–26 days (median 15 days). All survivors had mildly impaired (1 patient, LVEF 40 %) or preserved (6 patients, LVEF 55–65 %) left ventricular systolic function at the time of discharge from ICU. The cause of death of non-survivors (three patients) was acute myocarditis, massive retroperitoneal bleeding, and massive gastrointestinal bleeding.Discussion and ConclusionsOur data confirm the high survival rate (70 %) and excellent neurologic outcome in hypothermic cardiac arrest. The following key elements seem to impact the final prognosis: the appropriate coordination of the rescue operation, immediate high-quality CPR (preferably using mechanical chest compression system) and application of ECMO for rewarming and cardiorespiratory support.