Michał Holecki

Publications of Michał Holecki

• Changes of bone mineral density in obese perimenopausal women during 5-year follow-up.

  Authors: Michał Holecki, Jerzy Chudek, Magdalena Titz-Bober, Andrzej Więcek, Barbara Zahorska-Markiewicz, Jan Duława

  Polskie Archiwum Medycyny Wewnetrznej. 02/2012;

  INTRODUCTION The beneficial and protective influence of obesity on bone mineral mass has not been definitely established. OBJECTIVES To evaluate the changes of bone mineral density (BMD) in obeseINTRODUCTION The beneficial and protective influence of obesity on bone mineral mass has not been definitely established. OBJECTIVES To evaluate the changes of bone mineral density (BMD) in obese perimenopausal women during 5-year follow-up. PATIENTS AND METHODS 54 women with simple obesity were enrolled into the study. The study group was divided into 2 subgroups according to menopausal status: postmenopausal women – M (n=35) and premenopausal women – P (n=19). Blood analyses (parathyroid hormone, 25-hydroxyvitamin D3, C-terminal telopeptide of type I collagen, osteocalcin, and osteoprotegerin), anthropometric measurements and densitometry were performed twice, in a 5-year interval. The control group consisted of 19 healthy, non-obese women of the same age. RESULTSPostmenopausal obese women were characterized by lower BMD in proximal femur and lumbar spine, higher fracture risk and higher serum concentration of osteocalcin at the beginning of observation. During 5-year follow-up, there was a 1.52% and 6.86% decrease in proximal femur BMD (p<0.01) and 2.34% and 5.17% of lumbar spine BMD in premenopausal and postmenopausal obese women, respectively. In postmenopausal controls, BMD reduction in the evaluated areas was 2.36% and 4.3% respectively. In the combined analysis including all postmenopausal women, there was an inverse correlation between initial body mass index (BMI) (R=-0.252; p<0.05) and changes of proximal femur and lumbar spine BMD (R=-0.280; p=0.08) that occurred over the 5-year period. CONCLUSIONSObesity seems not protect against bone mineral loss in postmenopausal women.

• [Diagnostic value of antineutophil cytoplasmic antibodies].

  Authors: Agnieszka Zak-Gołab, Antoni Hrycek, Michał Holecki, Jerzy Chudek

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(1):37-42.

  Antineutrophil cytoplasmic antibodies (ANCA) constitute a family of auto-antibodies directed against various components of the neutrophil cytoplasm. The indirect immunofluorecence assays detectedAntineutrophil cytoplasmic antibodies (ANCA) constitute a family of auto-antibodies directed against various components of the neutrophil cytoplasm. The indirect immunofluorecence assays detected three fluorescent staining patterns: cANCA--cytoplasmic; pANCA--perinuclear and aANCA--atypical. Occurence ANCA is mainly associated with Wegener's granulomatosis and vasculitis, but they are also detected in autoimmune diseases (eg. in systemic lupus erythematosus, in rheumathoid arthritis, Sjögren's syndrome, in dermatomyositis) and in inflamatory bowel diseases (Crohn disease, colitis ulcerosa). Presence of ANCA was found also in primary sclerosing cholangitis, in chronic infections and in person using some kinds of drugs. The aim of the study was to review recent investigations concerning prevalence of ANCA and their diagnostic value not only for vasculitis but also for the other disease in which they are detected.

• Relationship between body fat mass and bone metabolism.

  Authors: Michał Holecki, Andrzej Wiecek

  Polskie Archiwum Medycyny Wewnętrznej. 09/2010; 120(9):361-7.

  The protective effect of obesity on bone tissue has not been unequivocally demonstrated. On one hand, it is known that obese people have a lower risk of osteoporotic fractures compared withThe protective effect of obesity on bone tissue has not been unequivocally demonstrated. On one hand, it is known that obese people have a lower risk of osteoporotic fractures compared with normal-weight individuals. On the other hand, obese patients are characterized by disorders of calcium-phosphate homeostasis and bone metabolism. Moreover, it is not known whether it is fat or lean body mass that determines the development of bone mass. It can be assumed that adipose tissue exerts independent effects on bone remodeling by releasing a number of biologically active substances. Moreover, it seems that the main mechanism of action of these substances is closely related to the type and location of adipose tissue in the body. The present article describes the relationship between fat and bones, including the effect of body weight on bone tissue, the local mechanisms of osteoblast and adipocyte differentiation, and the hormonal activity of adipose tissue.

• Changes in bone mineral density and bone turnover markers in obese women after short-term weight loss therapy during a 5-year follow-up.

  Authors: Michał Holecki, Barbara Zahorska-Markiewicz, Jerzy Chudek, Andrzej Wiecek

  Polskie Archiwum Medycyny Wewnętrznej. 07/2010; 120(7-8):248-54.

  The protective effect of adipocity on bone metabolism has not been confirmed during long-term follow-up. It is not known whether the rate of bone turnover and changes in mineral metabolism in obeseThe protective effect of adipocity on bone metabolism has not been confirmed during long-term follow-up. It is not known whether the rate of bone turnover and changes in mineral metabolism in obese people result from endocrine properties of the adipose tissue or merely the mechanical load. The aim of the study was to evaluate bone and calcium-phosphorus metabolism in obese women during a 5-year follow-up. The study involved 47 obese women who underwent a 3-month weight loss therapy. We evaluated changes in the serum levels of parathormone (PTH), calcidiol (25(OH)D3), collagen type I crosslinked C-telopeptide (CTx-I), osteocalcin, total calcium, inorganic phosphates, and in bone mineral density. The control group consisted of 17 healthy women with proper body weight. We observed a similar decrease in bone mineral density (BMD) in the lumbar spine and femoral neck, and a comparable decrease in the serum levels of CTx-I and osteocalcin in both groups during the 5-year follow-up. Changes in serum PTH levels were not statistically significant. In obese women, a nonsignificant increase in the serum level of 25(OH)D3 was observed as early as after a 3-month weight loss therapy and during follow-up. In controls, serum 25(OH)D3 levels tended to decrease. During follow-up, the number of obese patients with disturbances in vitamin D metabolism decreased from 78.7% to 53.2% (P = 0.01). Such disturbances were observed in 35.3% of the control group. In obese patients, there was a positive correlation between the change in body mass and BMD in the proximal femur (r = 0.279, P = 0.04). In controls, there was a positive correlation between the change in body mass and BMD in the lumbar spine (r = 0.477, P = 0.05). In obese women who underwent weight loss therapy, the levels of bone turnover markers decreased and abnormal vitamin D metabolism was still observed during the 5-year follow-up.

• In-stent coronary restenosis, but not the type of stent, is associated with impaired endothelial-dependent vasodilatation.

  Authors: Katarzyna Mizia-Stec, Zbigniew Gasior, Maciej Haberka, Magdalena Mizia, Artur Chmiel, Joanna Janowska, Michał Holecki, Marcin Mielczarek, Barbara Zahorska-Markiewicz

  Kardiologia polska. 01/2009; 67(1):9-17; discussion 18.

  BACKGROUND: Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate. AIM: To compareBACKGROUND: Precise mechanisms leading to restenosis are not fully understood. The type of implanted stent and the intensity of atherogenic processes may affects the restenosis rate. AIM: To compare the long-term effects of the coronary stent implantation - paclitaxel-eluting stent (PES) or bare-metal stents (BMS) - on endothelial-dependent flow-mediated dilation (FMD), platelet-derived growth factor (PDGF) and asymmetric dimethylarginine (ADMA) serum levels and to assess the relationship between FMD, PDGF, ADMA and every-stage in-stent restenosis (eISR). Methods: The study population included 40 patients with coronary artery disease, who underwent elective percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) with stent implantation (PES - 21 patients; BMS - 19 patients). Follow-up examination was performed 12 months after PCI. RESULTS: There were no differences between the PES and the BMS patients regarding FMD (PES: 11.8+/-7.8%, BMS: 10.5+/-9.2%), PDGF (PES: 5540+/-2209 pg/ml, BMS: 4923+/-2924 pg/ml) and ADMA (PES: 0.474+/-0.04 micromol/l, BMS: 0.456+/-0.03 micromol/l) serum levels. The follow-up angiography was performed when clinically indicated in 25 patients: in 15 patients with PES and 10 patients with BMS implanted. The eISR was found in 12 subjects: in 7 (47%) with PES and in 5 (50%) with BMS (NS). In all patients with eISR, the FMD values were significantly lower (6.1+/-3.5%, p=0.003) compared to the patients without eISR (14.3+/-7.8%). FMD was the only independent risk factor for eISR (OR=0.631, 95% CI 0.412-0.942, p=0.0003). The cut-off point for FMD < or = 8.4% as a parameter predicting eISR was established (p=0.0001, sensitivity: 83.3%, specificity: 92.3%, PPV: 90.9%, NPV: 85.7%). CONCLUSIONS: The type of stent implanted into LAD does not affect the FMD, PDGF and ADMA serum levels assessed one-year after a PCI procedure. The occurrence of an early in-stent restenosis is associated with impaired FMD at the time of one-year follow-up.

• Serum ADMA concentration-- an independent factor determining FMD impairment in cardiac syndrome X.

  Authors: Maciej Haberka, Katarzyna Mizia-Stec, Zbigniew Gasior, Magdalena Mizia, Joanna Janowska, Michał Holecki, Barbara Zahorska-Markiewicz

  Upsala journal of medical sciences. 01/2009; 114(4):221-7.

  Mechanisms of decreased endogenous vascular reactivity in individuals with cardiac syndrome X (CSX) are not fully understood. AIM: To evaluate the following serum markers: total nitric oxide (NO),Mechanisms of decreased endogenous vascular reactivity in individuals with cardiac syndrome X (CSX) are not fully understood. AIM: To evaluate the following serum markers: total nitric oxide (NO), asymmetric dimethylarginine (ADMA), platelet-derived growth factor (PDGF), and to establish their relation to ultrasound indexes of endothelial function and structural remodeling in CSX patients. METHOD: The study group consisted of 43 CSX patients (mean age: 56.3 +/- 9 years), while the control group included 21 healthy subjects (mean age: 54.86 +/- 6.9 years). The high-resolution ultrasound was performed to measure: flow-mediated vasodilatation (FMD), nitroglycerine-mediated vasodilatation (NMD) and intima-media thickness (IMT) of carotid arteries. RESULTS: In CSX patients, significantly lower FMD (9.06 +/- 3.2%) and significantly higher IMT (0.667 +/- 0.14 mm) values were observed compared to healthy individuals (17.42 +/- 8.4%, 0.571 +/- 0.2 mm; P < 0.05). Mean total NO serum concentration was significantly higher in the CSX group (48.2 +/- 18.2 micromol/L) as compared to controls (32.1 +/- 1.4 micromol/L; P < 0.0001). There were no differences in serum ADMA and PDGF levels. In CSX patients, FMD values correlated with NO (r = 0.323; P = 0.039) and ADMA (r = -0.387; P = 0.012) serum levels; however, there were no significant correlations between NO and ADMA concentrations. CONCLUSION: Serum ADMA concentration is the only independent factor determining FMD impairment.

• The indexes of arterial structure and function in women with simple obesity: a preliminary study.

  Authors: Katarzyna Mizia-Stec, Zbigniew Gasior, Barbara Zahorska-Markiewicz, Michał Holecki, Maciej Haberka, Magdalena Mizia, Szymon Gomułka, Agnieszka Zak-Gołab, Adrianna Gościńska

  Heart and vessels. 07/2008; 23(4):224-9.

  Obesity is associated with an increased risk of cardiovascular disorders. The aim of the present study was to compare the indexes of arterial structure and function in women with simple obesity andObesity is associated with an increased risk of cardiovascular disorders. The aim of the present study was to compare the indexes of arterial structure and function in women with simple obesity and healthy individuals. Twenty-two women with simple obesity (body mass index [BMI]: 33.6 +/- 2.9 kg/m(2), age: 29.7 +/- 6.2 years), and 34 healthy women were included in the study. Healthy subjects were divided into two subgroups according to their age (<35 and >45 years): Control A-16 young women (age <35 years, BMI: 24.0 +/- 3.0 kg/m(2)), and Control B-18 older women (age >45 years, BMI: 25.8 +/- 2.9 kg/m(2)). Noninvasive, high-resolution, vascular ultrasound was used to evaluate the endothelial-dependent vasodilatation: flow-mediated dilatation of brachial artery (FMD); the arterial structure: intima-media thickness (IMT) of common carotid artery (CCA); and the compliance parameters corresponding to structural changes in large arteries (PWV: pulse wave velocity; PP: pulse pressure; TAC: total arterial compliance; Ao C: aorta compliance, CCA C: CCA compliance, stiffness indexes). Endothelial-dependent vasodilatation as represented by FMD was comparable in the obese group (16.8% +/- 7.9%; median: 15.5%) and healthy subjects (Control A: 14.1% +/- 4.7%; median: 13.6%; Control B: 13.9% +/- 6.5%; median: 13.0%). The mean value of IMT was significantly increased (P < 0.05) in Control B group (0.67 +/- 0.07 mm) in comparison to both obese patients (0.58 +/- 0.09 mm) and Control A group (0.53 +/- 0.05 mm). The compliance parameters (PWV, AoC, CCA C, stiffness indexes) were impaired in obese patients and Control B patients as compared to Control A individuals. PWV and stiffness indexes were significantly increased, and the AoC, CCA C-diameter, CCA C-area were significantly decreased. Simple obesity constitutes an important risk factor accelerating arterial stiffness in women.

• [Obesity and bone metabolism.]

  Authors: Michał Holecki, Barbara Zahorska-Markiewicz, Andrzej Więcek, Teresa Nieszporek, Agnieszka Zak-Gołąb

  Endokrynologia Polska. 02/2008; 59(3):218-223.

  Both bone and adipose tissue change their size, shape and distribution during the whole human being's life. Many factors, including genetic factors, hormones and activity of nervous system areBoth bone and adipose tissue change their size, shape and distribution during the whole human being's life. Many factors, including genetic factors, hormones and activity of nervous system are responsible for these changes. It is generally accepted that obesity has a protective effect on bone tissue. On the other hand some authors present an opposite results - the lack of beneficial effect of obesity on development of osteoporosis fractures. The aim of this article was to present and discuss the relations between adipose tissue and bone metabolism.

• Long-term effects of lipase inhibition by orlistat on gastric emptying and orocecal transit time of a solid meal.

  Authors: Piotr Kocełak, Barbara Zahorska-Markiewicz, Krzysztof Jonderko, Magdalena Olszanecka-Glinianowicz, Agnieszka Zak-Gołab, Michał Holecki, Magdalena Kamińska, Małgorzata Szymszal

  Journal of gastroenterology. 01/2008; 43(8):609-17.

  BACKGROUND: We assessed the impact of a prolonged lipase inhibition upon gastric emptying (GE) and orocecal transit time (OCTT) of a 355-kcal low-fat solid meal. METHODS: In double-blind manner, 40BACKGROUND: We assessed the impact of a prolonged lipase inhibition upon gastric emptying (GE) and orocecal transit time (OCTT) of a 355-kcal low-fat solid meal. METHODS: In double-blind manner, 40 obese women BMI > 30 kg/m2, randomly allocated into two equal groups, took orally t.i.d. 120 mg orlistat or placebo during 8 weeks of a weight-reducing management. At randomization and after 2 months, GE was measured simultaneously with OCTT by means of a 13C-octanoic acid and a hydrogen breath test, respectively. Lipolytic activity was evaluated with a 13C-mixed triglyceride breath test (13C-MTGBT). RESULTS: A profound lipase inhibition by orlistat was confirmed by a 79.5% +/- 16.9% reduction of the cumulative 6-h 13C recovery with 13CMTGBT. GE remained unchanged either in the orlistat (T1/2, 188 +/- 35 min start versus 198 +/- 36 min end) or the placebo (T1/2, 191 +/- 35 min start versus 180 +/- 39 min end) group. OCTT increased from 208 +/- 54 min to 271 +/- 64 min (P < 0.01) after orlistat treatment and did not change significantly (216 +/- 76 vs. 234 +/- 72 min) in the placebo group. CONCLUSIONS: No adverse effect on the GE and a moderate prolongation of the OCTT of a low-fat solid meal is to be expected under a prolonged treatment with orlistat at a typical dosage regimen.

• Influence of calcium and vitamin D supplementation on weight and fat loss in obese women.

  Authors: Michał Holecki, Barbara Zahorska-Markiewicz, Andrzej Wiecek, Katarzyna Mizia-Stec, Teresa Nieszporek, Agnieszka Zak-Gołab

  Obesity facts. 01/2008; 1(5):274-9.

  Dairy products not only reduce the risk of hypertension and cardiovascular diseases but may play a role in the treatment of obesity. As there is some evidence that calcium (Ca) and vitamin D may playDairy products not only reduce the risk of hypertension and cardiovascular diseases but may play a role in the treatment of obesity. As there is some evidence that calcium (Ca) and vitamin D may play a role in effective weight management, we decided to evaluate the influence of Ca and vitamin D supplementation on weight and fat loss in obese women. Forty obese women were enrolled in this study. Subjects were divided into 2 groups comparable with body mass index (BMI) and age. Group 1 was provided with calcium carbonate and 1-(OH)-vitamin D supplementation. Group 2 was provided with only a diet. Subjects participated in a 3-month weight reduction therapy (balanced diet, modification of life style, and regular physical exercise). Blood samples (serum concentration of Ca, phosphorus (P), parathormone (PTH), 25-(OH)-D3) and clinical characteristics (weight, height, BMI, body composition) were taken at baseline and after the 3-month program. No significant differences of body weight, body fat content, serum parathormone, 25-(OH)-D3 concentration, and plasma total Ca and P concentration were observed between analyzed groups both before and after the treatment. Additionally, we did not observe any significant influence of Ca and vitamin D supplementation on weight and fat loss. Ca plus vitamin D supplementation during a 3-month low caloric diet has no additional effect on weight and fat loss in obese women.

• Flow-mediated dilation and gender in patients with coronary artery disease: arterial size influences gender differences in flow-mediated dilation.

  Authors: Katarzyna Mizia-Stec, Zbigniew Gasior, Magdalena Mizia, Maciej Haberka, Michał Holecki, Weronika Zwolińska, Kańczuga Katarzyna, Mariusz Skowerski

  Echocardiography (Mount Kisco, N.Y.). 11/2007; 24(10):1051-7.

  BACKGROUND: The risk of atherosclerosis and its complications differs between male and female subjects. This is probably associated with gender differences in endothelial function as reflected byBACKGROUND: The risk of atherosclerosis and its complications differs between male and female subjects. This is probably associated with gender differences in endothelial function as reflected by endothelium-dependent vasodilation. The aim of the study was to compare flow-mediated dilatation (FMD) in males and females with coronary artery disease (CAD), and to determine factors that might potentially influence FMD. METHODS: Ninety-six patients with stable CAD (CCS II-III): 76 males (mean age: 57.7 +/- 10 years) and 20 postmenopausal females (mean age: 60.1 +/- 10 years) were included into the study. Clinical data, pharmacotherapy, concomitant diseases, and FMD were all assessed. FMD was measured with high-resolution ultrasound as the percent change of brachial artery diameter (BAd) after a 3-minute occlusion (%FMD), and following the administration of 0.4 mg sublingual nitroglycerin (%NTG-MD). RESULTS: The percentage of FMD was significantly decreased (P < 0.05), and BAd was significantly larger (P < 0.001) in males as compared to females. Clinical data, pharmacotherapy, and concomitant diseases were comparable in the study groups.In all subjects examined, %FMD was related to BAd (r =-0.415, P < 0.001) and the percentage of ejection fraction (EF%) (r = 0.325, P < 0.01) in the univariate analysis, and to BAd only (r =-0.343, P < 0.01) in the multivariate analysis. The percentage of nitroglycerine-mediated vasodilatation (NTG-MD) correlated negatively with BAd (r =-0.430, P < 0.001), and positively with EF% (r = 0.334, P < 0.01) in the univariate analysis, and with BAd (r =-0.288, P < 0.05) in the multivariate analysis. Index %FMD x BAd was comparable for male and female subjects. CONCLUSIONS: Males and postmenopausal females with CAD show differences in endothelium-dependent vasodilatation that seem to secondarily result from differences in the BAd. Objective comparison of %FMD is only possible between patients with the same brachial artery size.

• Serum concentration of visfatin in obese women.

  Authors: Barbara Zahorska-Markiewicz, Magdalena Olszanecka-Glinianowicz, Joanna Janowska, Piotr Kocełak, Elzbieta Semik-Grabarczyk, Michał Holecki, Piotr Dabrowski, Anna Skorupa

  Metabolism: clinical and experimental. 09/2007; 56(8):1131-4.

  The aim of the present study was to determine serum concentrations of visfatin in obese women in comparison to normal-weight controls. Study subjects were 21 obese women without additional diseaseThe aim of the present study was to determine serum concentrations of visfatin in obese women in comparison to normal-weight controls. Study subjects were 21 obese women without additional disease (age, 29.0+/-4.9 years; body mass index, 37.1+/-6.1 kg/m2) and 16 healthy, normal-weight women (age, 29.9+/-5.4 years; body mass index, 22.5+/-1.7 kg/m2). Body composition was measured by bioimpedance. Serum concentrations of visfatin were assayed with an enzyme-linked immunosorbent assay kit (Phoenix Pharmaceuticals, Burlingame, CA). Insulin was determined by radioimmunoassay and glucose by colorimetric method. Serum concentration of visfatin was significantly higher in obese women when compared to controls. Positive correlations between serum concentrations of visfatin and insulin in the obese group were found. In the control group, we observed positive correlations between serum concentrations of visfatin and glucose. In conclusion, the observed increase of visfatin in obesity may be a counterregulation preventing further glucose increase.

• The influence of weight loss on serum osteoprotegerin concentration in obese perimenopausal women.

  Authors: Michał Holecki, Barbara Zahorska-Markiewicz, Joanna Janowska, Teresa Nieszporek, Katarzyna Wojaczyńska-Stanek, Agnieszka Zak-Gołab, Andrzej Wiecek

  Obesity (Silver Spring, Md.). 09/2007; 15(8):1925-9.

  OBJECTIVE: To assess the influence of weight reduction therapy on serum osteoprotegerin (OPG) concentration in obese patients and compare these results with normal-weight controls. RESEARCH METHODSOBJECTIVE: To assess the influence of weight reduction therapy on serum osteoprotegerin (OPG) concentration in obese patients and compare these results with normal-weight controls. RESEARCH METHODS AND PROCEDURES: Forty-three obese women (BMI, 36.7 +/- 4.1 kg/m2; mean age, 50.1 +/- 4.5 years) were studied. The control group consisted of 19 normal-weight women (BMI, 24.2 +/- 2.1 kg/m2; mean age, 53.8 +/- 5.2 years). In all patients, serum concentrations of OPG, C telopeptide of type I collagen containing the cross-linking site (CTX), osteocalcin, parathormone, 25-(OH)-D3 (vitamin D), and total calcium and phosphorus were assessed before and after a 3-month weight reduction therapy. RESULTS: In obese subjects, serum concentrations of OPG, 25-(OH)-D3, osteocalcin, total calcium, and phosphorus were significantly lower, and serum concentration of parathormone was significantly higher, before weight reduction therapy in comparison with normal-weight controls. After weight reduction, a significantly higher serum concentration of 25-(OH)-D3 and CTX and significantly lower concentration of OPG were found. DISCUSSION: Serum concentration of OPG was significantly lower in obese patients in comparison with normal-weight controls. Weight reduction therapy resulted in further decrease in OPG serum concentrations. Therefore, OPG cannot be treated as a protective factor from bone loss in obese patients.

• Inflammatory markers in a 2-year follow-up of coronary artery disease.

  Authors: Katarzyna Mizia-Stec, Zbigniew Gasior, Barbara Zahorska-Markiewicz, Michał Holecki, Paweł Kumor

  Heart and vessels. 09/2006; 21(5):302-8.

  Our study was designed in an attempt to determine the dynamics of changes in serum tumor necrosis factor (TNF)-alpha, soluble forms of its receptors (sTNFR 1, sTNFR 2), and adhesion moleculesOur study was designed in an attempt to determine the dynamics of changes in serum tumor necrosis factor (TNF)-alpha, soluble forms of its receptors (sTNFR 1, sTNFR 2), and adhesion molecules (sE-selectin, sP-selectin, sVCAM-1, sICAM-1) over a 2-year follow-up of patients with coronary artery disease (CAD). The study involved 70 patients with stable CAD (stable angina class II/III according to the Canadian Cardiovascular Society) and 20 apparently healthy subjects. Over the follow-up period a marked attenuation of angina (P<0.001) was observed. Interventional treatment (percutaneous coronary intervention, coronary artery bypass grafting) was used in 53 CAD patients. Laboratory analysis revealed a significant decrease of serum TNF-alpha and sTNFR1 at 2 years (TNF-alpha: 12.1+/-0.7 pg/ml; sTNFR 1: 1306+/-46 pg/ml) as compared to baseline levels (16.5+/-0.7 pg/ml, P=0.030; 1551+/-82 pg/ml, P=0.048, respectively). The levels of sP-selectin (159+/-7 vs 201+/-14 ng/ml, P<0.01) and sICAM-1 (133+/-4 vs 153+/-6 ng/ml, P<0.05) were found to be significantly increased as compared to the baseline. Interventional procedures resulted in suppression of both cytokine (TNF-alpha, sTNFR 2) and adhesion molecule (sE-selectin, sP-selectin) activation in the CAD group. The baseline and post-follow-up TNF-alpha and sTNFR 1 levels showed persistent elevation in CAD patients as compared to the controls (9.0, 956.3 pg/ml, respectively; P<0.01). There were no differences between baseline and final cytokines and adhesion molecules in healthy subjects. The course of CAD as modified by a clinically effective therapy is characterized by changes of immune markers activation. Revascularization seems to be an important factor suppressing both cytokine and adhesion molecule activation in CAD patients.

• [Coronary artery disease and menopausal hormone therapy]

  Authors: Katarzyna Mizia-Stec, Barbara Zahorska-Markiewicz, Zbigniew Gasior, Michał Holecki

  Polskie archiwum medycyny wewnȩtrznej. 11/2004; 112(4):1255-63.

• Ghrelin as a potential blood pressure reducing factor in obese women during weight loss treatment.

  Authors: Katarzyna Mizia-Stec, Barbara Zahorska-Markiewicz, Magdalena Olszanecka-Glinianowicz, Joanna Janowska, Zbigniew Mucha, Michał Holecki, Zbigniew Gasiora

  Endokrynologia Polska. 59(3):207-11.

  Background: In animal models ghrelin reduces cardiac afterload and increases cardiac output via receptors in the cardiovascular system. The aim of our study was to evaluate a potential relationshipBackground: In animal models ghrelin reduces cardiac afterload and increases cardiac output via receptors in the cardiovascular system. The aim of our study was to evaluate a potential relationship between weight loss treatment, blood pressure and serum ghrelin concentrations in obese women. Material and methods: A group of 37 obese premenopausal women with no previous history of hypertension (BMI: 36.5 +/- 5 kg/m(2)) were involved in the study. Blood pressure and serum ghrelin levels were assessed before and after a three-month weight reduction treatment, which consisted of a diet of 1000 kcal/day and physical exercise. Body composition was determined by impedance analysis using Bodystat. Results: Following weight loss (mean 8.9 +/- 4.8 kg) SBP decreased (120 +/- 13 vs. 115 +/- 14 mm Hg, p = 0.01) and serum ghrelin levels increased significantly (66.9 +/- 13.7 vs. 73.9 +/- 15.4 pg/ml; p = 0.005). There were significant correlations between values for ghrelin levels after weight loss and SBP (r = -0.45, p = 0.02), DBP (r = -0.41, p < 0.05), and between Dghrelin levels and DSBP (r = 0.52, p = 0.006), DDBP (r = 0.53, p = 0.005). There was a positive correlation between an increase in ghrelin and a decrease in percentage body fat during weight loss (r = 0.51; p = 0.002). Conclusion: The results seem to provide evidence that weight loss may decrease blood pressure in obese patients via a ghrelin-dependent mechanism.

• Osteoprotegerin--does it play a protective role in the pathogenesis of bone loss in obese perimenopausal women?

  Authors: Michał Holecki, Barbara Zahorska-Markiewicz, Joanna Janowska, Katarzyna Mizia-Stec, Agnieszka Zak-Gołab, Magdalena Olszanecka-Glinianowicz, Katarzyna Wojaczyńska-Stanek, Teresa Nieszporek, Andrzej Wiecek

  Endokrynologia Polska. 58(1):7-10.

  INTRODUCTION: Assessment of serum osteoprotegerin (OPG) concentrations in obese patients in comparison to healthy controls and evaluation of a possible correlation between OPG and other markers ofINTRODUCTION: Assessment of serum osteoprotegerin (OPG) concentrations in obese patients in comparison to healthy controls and evaluation of a possible correlation between OPG and other markers of bone turnover or calcitropic hormones. MATERIAL AND METHODS: 50 obese perimenopausal women without concomitant diseases (BMI 36.7 +/- 4.1 kg/m(2), mean age 50.4 +/- 4.9 yrs). The control group consisted of 19 healthy women (BMI 24.2 +/- 2.1 kg/m(2); mean age 53.8 +/- 5.1 yrs). In all patients serum concentration of OPG, C telopeptide of type I collagen containing the crosslinking site (CTX), osteocalcin, parathormone (PTH) and vitamin D (25-OH-D(3)) was assessed. Dual energy x-ray absorptiometry (the DXA method) of the lumbar spine and femoral neck was performed using a Lunar DPXL to measure bone marrow density (BMD). RESULTS: In obese perimenopausal women serum OPG, osteocalcin and 25-OH-D(3) levels were significantly lower, and the serum PTH level was significantly higher in comparison to healthy controls. A significantly positive correlation was found between serum OPG level and age in both obese and control subjects. CONCLUSION: The serum OPG level in obese perimenopausal women is significantly lower in comparison to healthy controls and does not correlate significantly with biochemical markers of bone turnover, calcitropic hormones and BMD. It probably cannot play a protective role in the pathogenesis of bone loss in obese perimenopausal women.

• [The effect of weight loss on serum concentration of interleukine-6 (IL-6) and insulin resistance]

  Authors: Magdalena Olszanecka-Glinianowicz, Barbara Zahorska-Markiewicz, Piotr Kocełak, Joanna Janowska, Michał Holecki, Elzbieta Semik-Grabarczyk

  Endokrynologia Polska. 57(2):131-5.

  INTRODUCTION: Interleukine-6 (IL-6) is one of the cytokines, excreting by adipocytes, which increases in obesity. These cytokines participate in very complicated mechanisms of developing insulinINTRODUCTION: Interleukine-6 (IL-6) is one of the cytokines, excreting by adipocytes, which increases in obesity. These cytokines participate in very complicated mechanisms of developing insulin resistance that accompany obesity. The aim of the study was to: 1) evaluate the influence of weight loss on insulin resistance and serum concentration of IL-6, 2) evaluate the hypothetical association between serum concentration of IL-6 and the improvement of insulin sensitivity in obese women after weight loss. MATERIAL AND METHODS: The study involved 27 obese women (age 40.3 +/- 11.1 year; BMI 37.4 +/- 5.2 kg/m(2)) with insulin resistance diagnosed using HOMA index, without concomitant diseases and without any medication. All the patients participated in complex weight reduction treatment (diet, physical activity and psychotherapy). Before and after weight reduction therapy weight and height were measured, body composition was determined using bioimpedance analysis. Serum concentration of glucose was determined by enzymatic procedure, serum concentration of insulin was measured by radioimmunoassay, serum concentration of IL-6 was measured by ELISA. HOMA index was calculated with formula. RESULTS: The mean weight loss after 3-month was 9.2 +/- 4.5 kg (approximately 10% of initial weight). After weight reduction significant decreases in HOMA index, insulin and IL-6 concentrations was observed. However, no correlations between changes in insulin concentrations, HOMA index and decrease of IL-6 concentration were showed. We observed significant correlations between DeltaHOMA and DeltaBMI (r = 0.48; p = 0.012) and Delta percentage fat mass (r = 0.39; p < 0.05). CONCLUSIONS: A moderate weight loss improves insulin sensitivity and decreases serum concentrations of IL-6. However improvement of insulin sensitivity is the effect of fat mass reduction and does not change serum concentration of IL-6.

• Diagnostic dilemmas in a patient with anaemia. Empty sella syndrome--a case report.

  Authors: Michał Holecki, Edyta Rembiesa-Jarosińska, Agata Fryźlewicz-Moska, Jan Duława

  Endokrynologia Polska. 61(4):400-3.

  Empty sella syndrome is defined as a group of clinical symptoms developing as a result of herniation of the subarachnoid space within the sella, which is often associated with some degree ofEmpty sella syndrome is defined as a group of clinical symptoms developing as a result of herniation of the subarachnoid space within the sella, which is often associated with some degree of flattening of the pituitary gland. It is usually recognized incidentally during brain imaging studies performed for different indications, and in most cases this condition is asymptomatic. However, it may result in impairment of various endocrine glands, for which the pituitary gland produces its crinins. Despite the high incidence of empty sella syndrome (up to about 5% of the population) it is commonly ignored as the cause of various symptoms. We present a case of 55-year-old patient admitted to the department of internal medicine due to anaemia and progressive weakness, with recognized hypothyroidism and adrenal gland insufficiency in the course of empty sella syndrome.

• Effects of angiotensin-converting enzyme inhibitors beyond lowering blood pressure--are they important for doctors?

  Authors: Michał Holecki, Jan Szewieczek, Jerzy Chudek

  Pharmacological reports : PR. 63(3):740-51.

  Large clinical trials and experimental studies have indicated that not all of the beneficial properties of angiotensin-converting enzyme inhibitors (ACE-Is) can be attributed to the lowering of bloodLarge clinical trials and experimental studies have indicated that not all of the beneficial properties of angiotensin-converting enzyme inhibitors (ACE-Is) can be attributed to the lowering of blood pressure. The aim of this study was to assess doctors' opinions about the importance of the cardioprotective effects of ACE-Is beyond lowering blood pressure. The study participants (685 physicians) filled in a questionnaire testing doctors' knowledge of all of the therapeutic effects of ACE-Is not directly associated with lowering blood pressure and their clinical importance. In addition, each doctor filled in 20 questionnaires for subsequent patients treated with any ACE-I. Fifty-nine percent of the investigated physicians were aware of most of the therapeutic effects of ACE-Is. The most important therapeutic effects for the respondents were the following: reduction of peripheral resistance, inhibition of left ventricle hypertrophy, inhibition of vascular remodeling and atherosclerotic plaque stabilization. The most commonly prescribed ACE-Is were perindopril, lisinopril and chinalapril for inhibition of left ventricular hypertrophy and perindopril, ramipril and chinalapril for inhibition of arterial wall remodeling. The ACE-Is that were used to reduce peripheral vessel resistance included perindopril, lisinopril and trandolapril. Drugs used to stabilize the plaque included perindopril, lisinopril and cilazapril. The therapeutic effects of ACE-Is beyond lowering blood pressure were considered to be valid and important in daily clinical practice for the prevention of cardiovascular diseases and diabetic complications. The attribution of the effects of a particular ACE-I was not always in accordance with evidence-based medicine. The obtained treatment outcomes were attributed to the entire group of ACE-Is.