[The ankle-arm index and whole blood viscosity in patients with type II diabetes mellitus with ischemia of the lower extremities]

The relationship was studied between the ankle-arm index (K/R) and whole blood and plasma viscosity in patients suffering from diabetes mellitus type II with ischemia of lower extremities. The measurements were carried out in 96 patients (80 males and 16 females), of whom 72 were in stage II of Fontaine progression. Immediately after determination of the K/R index blood was taken from vena mediana cubiti adding Na2EDTA for rheological test. Whole blood viscosity was measured with a Low-Shear 100 Contraves viscometer immediately after sampling, and plasma viscosity was measured with a capillary viscometer of Ubbvelohd within 2 hours after sampling. By the method of regression analysis and linear correlation it was found that increased whole blood and plasma viscosity significantly correlated with reduced K/R value in the patients. The obtained results are analysed in biophysical and clinical aspects.

[Cytoenzymatic and ultramicroscopic investigations of blood in coke oven workers]

White blood cell count, cytoenzymology (acid and alkaline phosphatase, beta-glucuronidase and myeloperoxidase of granulocytes) and ultrastructure of granulocytes and NBT reduction test were performed in peripheral blood obtained from cokery plant workers. All the subjects were divided into groups according to degree of exposure to BaP. Occupational exposure to many factors during coke production, especially to high concentration of BaP cause perceptible changes of NBT reduction test in the group more exposed workers. A statistically significant of the totally activity of the acid phosphatase and beta-glucuronidase of granulocytes were found in this risk group. The changes in granulocyte function correlated with ultrastructural changes. The coking plant environment represent a strong stimulator of the neutrophil metabolism.

[Certain complications of diabetes mellitus in old age]

The incidence rate of the diabetes mellitus in the aged patients has been analyzed. The clinical picture, complications, and the treatment varieties were evaluated in 2260 patients observed in the diabetes dispensary. Among them this disease has been diagnosed in 500 patients after 60 year of life. The results of the observations were compared with that found in 160 patients with diabetes diagnosed before the 35 year of life. This analysis revealed that the insulin treatment decreases in the aged patients the retinopathy rate, that in them the hypersensitivity and the resistance against this hormone are rather exceptional.

[Clinical assessment of treatment results for atherosclerotic ischemia of the lower extremities with intraarterial ozone injections]

Ten injections of O3 into femoral arteries were administered to 50 patients with atherosclerotic ischemia of the lower extremities and to 49 diabetic patients. All patients were assessed clinically with the ankle-arm index, measurement of intermittent claudication distance prior to and after the treatment. The treatment showed a significant improvement in both groups manifested by an increase in ankle-arm index, and prolongation of the intermittent claudication distance by more than twice. The treatment of atherosclerotic ischemia of the lower extremities with O3 is both valuable and safe.

[Analysis of the causes and clinical course of anemia in elderly patients]

Anamnesis of patients treated for anemia at the Department of Internal and Occupational Diseases in Zabrze in 1984-1988 were analysed. It was found that the incidence of anemia in patients over 60 years of age was significantly higher. Decreased function of hematopoietic system, more frequent deficits of factors indispensable for the normal erythropoiesis, i.e. iron and vitamin B12, and coexisting diseases, especially neoplasms and uremia, predispose to anemia in this age group. Anemia seen in the group of patients with diabetes mellitus type 2 was most probably a result of the chronic treatment with sulfonylurea derivatives.

[Endoscopic picture of hemorrhage from the upper digestive tract in elderly patients]

The causes of upper gastrointestinal tract bleeding were analysed in 412 patients dividing them into age groups below and over 60 years. Both groups were compared using endoscopic classification of bleedings by Forrest. In the group aged over 60 years a significantly higher per cent of type II lesion was found, especially non-bleeding vascular stump protruding from the bottom of the ulcer. This lesion was associated in nearly half the cases with recurrence of bleeding. The finding of this endoscopic picture should suggest the necessity of a more radical operation, although the operative risk is higher in patients aged over 60 years.

[Different course of myocardial infarction in old age]

For the assessment of the peculiarities of acute myocardial infarction in patients aged over 60 years 100 patients with this disease treated at the Department of Internal and Occupational Diseases, Silesian Medical Academy were compared with 100 patients aged below 60 years. The location of myocardial infarction was similar in both groups. In the younger group premature ventricular beats were more frequent while in the older group supraventricular or ventricular tachycardia and left bundle branch block were more frequent. The death rate was much higher in the older group.

[Some hemostatic parameters after treatment with ozone in a group of patients with obliterative atherosclerosis of the lower extremities and in a group of patients with diabetes]

Basic hemostasis and fibrinolysis parameters have been analysed in the group of 35 patients with obliterative atherosclerosis and in 41 patients with diabetes mellitus treated with intra-arterial ozone in concentration of O2/O3 54 micrograms/cm3 O3. Assayed parameters were within normal values. However, a tendency to decreased blood coagulation following ozone therapy was more pronounced in patients with obliterative atheromatosis, than in these with diabetes mellitus.

[Ozone therapy and viscosity of blood and plasma, distance of intermittent claudication and certain biochemical plasma components in patients with occlusive arteriosclerosis of the lower limbs]

Blood and plasma viscosity, total lipids, triglycerides, total cholesterol, free fatty acids, fibrinogen, lipid-gram, and hematocrit were determined in 53 patients with occlusive arteriosclerosis in the lower limbs prior to and after ozone therapy. At the same time the distance of the intermittent claudication was measured. A significant prolongation of the distance walked painlessly, reduction in blood and plasma viscosity as well as the decrease in total cholesterol after therapy with ozone correlated with a decrease of the blood viscosity.

[Ozone therapy and viscosity of blood and plasma, distance of intermittent claudication and certain biochemical components in patients with diabetes type II and ischemia of the lower extremities]

Blood and plasma viscosity, total blood lipids, triglycerides, total cholesterol, free fatty acids, fibrinogen, hematocrit, and lipidogram were determined in patients with diabetes mellitus type II and coexisting symptoms of the obliterative arteriosclerosis of the lower limbs. Intermittent claudication distance has been measured parallel. The same tests have been carried out after ozone therapy. A significant improvement in the intermittent claudication and reduction in blood and plasma viscosity have been noted. There was statistically significant correlation between intermittent claudication decrease and blood viscosity reduction following ozone therapy.

[Evaluation of hepatic microsomal enzyme activity using C-l4-labeled aminopyrine breath test in patients with diabetes mellitus type 2 treated with tolbutamide]

Among 116 diabetic patients of the District Diabetic Polyclinic in Zabrze (51 type II treated with tolbutamide++, 36 type I treated with insulin, 29 type II treated with diet only) and 30 health persons functional microsomal hepatic fraction with ABT was assessed. Classical hepatic function test were done too. Among 49% patients under examination with type II diabetes treated with tolbutamide++ statistically significant decrease of value of ABT was observed as compared with other groups. Values of classical hepatic function tests in investigated patients were within normal values. Decrease in demethylation of aminopyrine shown as the abnormality in values of ABT can be considered as early symptom of hepatocyte damage caused by tolbutamide++. ABT is valuable method of appraising the liver's detoxication function in type II diabetes. Patients treated with tolbutamide++ should not receive any other drug known as inhibitor of microsomal enzymes of the liver.

[The course of liver cirrhosis not preceded by viral hepatitis with p articular reference to toxic etiology]

The study was aimed at analysing the epidemiological structure of patients with liver cirrhosis without HBsAg treated in 1980-1988. There were 231 of such cases in this period of time. The most frequent cause of liver cirrhosis in patients under 60 years of life was chronic alcoholism whereas 40% of the diagnosed liver cirrhosis in older persons was of unclear etiology. Patients complaints, clinical examinations, and results of the laboratory tests were analysed. The course of the disease was more severe in alcohol-produced liver cirrhosis leading to the haemorrhage from esophageal varices in 36%, and coma in 8% of cases. Alcohol-produced liver cirrhosis promoted other complications such as: cancer of the liver, hepato-renal syndrome or encephalopathy. Liver cirrhosis of unclear etiology in the elderly may be a consequence of the prolonged exposition to environmental pollutants. More severe course of alcohol-produced liver cirrhosis may depend on simultaneous action of two harmful factors: alcohol and environmental pollutants.

[Restoration of physiologic integrity of the gastrointestinal tract because of fever following partial jejuno-ileal anastomosis in extreme obesity]

The authors present three patients with fever of hectic profile following partial excluding jejuno-ileal anastomosis for extreme obesity. Cause of such a high fever was not detected in any patient. Despite the treatment with broad-spectrum antibiotics and intensive treatment no decrease in body temperature was achieved. Failure of these conservative methods forced surgeons to restore physiological integrity of the small intestine. Rapid normalization of body temperature and improvement in patients health status were noted after surgery.

[Blood and plasma viscosity versus claudication distance in patients with obliterative atherosclerosis of the lower limbs]

The aim of the investigations was to show the influence of increased blood and plasma viscosity on the claudication distance in patients with obliterative atherosclerosis of lower limbs. The investigations were carried out in 53 patients: 41 men and 12 women (group I, age 45-67 years). The control group consisted of 100 healthy persons (group II) with similar range of age. The rheological studies of blood were carried out by low-shear 100 Contraves viscometer, the plasma viscosity--by means of capillary viscometer. Moreover, the total lipids, alpha, pre-beta, beta-lipoproteins, triglycerides, total cholesterol, free fatty acids, fibrinogen and hematocrit of the blood were determined. The blood for above mentioned estimations was collected before testing of the claudication distance. A significant increase of blood and plasma has been shown as well as an increase of total lipids, fibrinogen, triglycerides, total cholesterol, free fatty acids. The alpha lipoproteins were significant decreased in patients with intermittent claudication compared to the controls. The claudication distance ranged 10-500 m (the mean: 143 +/- 119 m). The correlation between claudication distance and blood and plasma viscosity was significantly negative (r = -0.42, p less than 0.001 and r = -0.32, p less than 0.05 respectively). The obtained results indicated that an increase of blood and plasma viscosity in patients with obliterative atherosclerosis of lower limbs was correlated to the decrease of claudication distance.

[Various parameters of lipid metabolism after intra-arterial injections of ozone in patients with ischemia of the lower extremities and diabetes mellitus]

In 50 subjects with arteriosclerotic ischaemia of the lower extremities and 41 subjects with diabetes mellitus ozone was applied intra-arterially. Before and after the treatment serum lipids concentration was examined. In the group with arteriosclerotic ischemia significant decrease in cholesterol level and both his fractions was seen. Whereas in the group with diabetes the cholesterol LDL was significantly reduced. In both groups total lipids level serum was decreased. It suggests that ++ozone therapy set back the arteriosclerosis progress, normalized some parameters of lipid metabolism and improved HDL to LDL cholesterol fractions relationship.

[Blood and plasma viscosity and the distance of intermittent claudication in patients with type II diabetes and thrombophlebitis]

In 49 patients with insulin-resistant diabetes, with ischaemia of the lower extremities blood viscosity was measured at low coagulation rates and plasma viscosity was determined also. Moreover plasma measurements were done of total lipids, alpha-, pre-beta-, and beta lipoproteins, triglycerides, total cholesterol, free fatty acids, and, besides that, the hematocrit was measured. Immediately after blood sampling for rheological and biochemical investigations the distance of intermittent claudication was measured. A rather considerable increase of blood and plasma viscosity was noted in the patients in comparison with controls, other findings included disturbances of lipid metabolism, increased fibrinogen level, and a negative correlation between the distance of intermittent claudication and blood and plasma viscosity.

[Long-term oxygen therapy of chronic pulmonary heart disease]

Pulmonary artery pressure was measured in 70 patients with chronic bronchitis. Those with pulmonary hypertension underwent two hours oxygen therapy (flow 10-12 l/min). Those in whom a decrease of pulmonary artery pressure was observed were qualified for long term oxygen therapy (LTOT). In 32 patients which were qualified for LTOT, after a two week period of 18 hour per day oxygen therapy a decrease of systolic pulmonary arterial pressure from 336.1 mm Hg to 30.9 mm Hg and a decrease of mean pulmonary artery pressure from 25.9 to 23.2 mm Hg was observed.

[Some parameters of hemostasis in diabetic patients]

Parameters of blood coagulation and fibrinolysis in diabetic patients chronically treated with oral hypoglycaemic agents and insulin have been analysed. All examined patients were divided into four subgroups: I-treated with biguanides, II-treated with sulfonylurea derivatives, III-sulfonylurea and biguanide derivatives simultaneously, IV-treated with insulin. Observed decrease in haemostasis parameters and activation of fibrinolysis in patients treated with only biguanides seemed associated with favourable effect of these agents on the decrease in the risk of the thrombotic complications in diabetes mellitus.

[Usefulness of thermographic examination in the diagnosis of early peripheral ischemia of the extremities in patients with diabetes mellitus]

Vascular damage is the main complication of diabetes. An early sign of this complication is damage to the arterial and capillary vessels in the lower extremities with later impairment of peripheral blood flow. The aim of the present study was evaluation of the usefulness of thermography in the detection of early circulatory disturbances in the lower extremities during diabetes, and comparison of its results with those obtained in oscillometry. The study comprised 28 patients with type I diabetes aged from 16 to 57 years and 27 patients with type II diabetes aged from 35 to 65 years. The control group included 10 clinically health subjects in similar age group. It was found that thermographic changes were much more frequent than pains in the extremities and abnormal values of oscillometric++ index in diabetes type I and II. Nearly half the patients with evident thermographic disturbances had no oscillometric changes, and 2/3 of the patients felt no pains in the extremities.