An clinical observation of a female patient with glycogen storage disease type IIIb was presented. She died in 23 years of decompensation of hepatic cirrhosis. The disease was complicated by a diabetes considered as type 1 due to the necessity of regular insulin administration. Secondary diabetes due to exhaustion of pancreatic insulin secretion as a consequence of repetitive hypoglycaemias from early youth is more probable. New approaches to the nutritional management of these patients from early youth should be studied to prevent fetal outcome of this hereditary disease.

Key words: glycogenosis, hepatic cirrhosis, diabetes mellitus

We present a case history of a successful use of intragastric balloon as the intervention treatment of the obesity in a female patient with type 2 diabetes mellitus who was treated by metformine and intensified insulin regime.

Key words: type 2 diabetes mellitus, obesity, weight reduction, intragastric balloon

We repeatedly admitted to our department an obese patient with type 2 diabetes mellitus and long lasting unsatisfactory metabolic compensation. During the first hospitalization the patient took part in a program of weight reduction that resulted in the weight loss of 3 kg. At the same time we adjusted her treatment. Six months later she was hospitalized again with lumbosacral pain irradiating to both legs. The pain as well as muscle atrophy significantly limited her mobility. She reported unwanted weight loss, loss of appetite and general exhaustion. We considered GIT neoplasm because of tumor markers elevation. Repeated examinations excluded compressive, paraneoplastic and inflammatory etiology of the symptoms. Based on examination results and long lasting metabolic decompensation of diabetes mellitus the fast progress of diabetic neuropathy (Burns-Garland neuropathic syndrome) was very likely. The neuropathy became a target of the treatment. The real cause of the symptoms was subsequently revealed by MRI of lumbosacral region that showed L3/4 discs herniation with dural sac compression. Partial reposition of L3/4 was performed; patient is able to walk with crutches and pain symptoms abated. 

Key words: Burns-Garland syndrome, spondylolisthesis, compressive myelopathy

We present a case of a female patient with Crohn’s disease who underwent many various procedures for reflux and resection surgery and who suffered from secondary postprandial hypoglycemic syndrome. The patient developed frequent hypoglycemia and hypoglycemic coma as a part of dumping syndrome. Optimal solution was the insertion of the intravenous port permitting the administration of concentrated glucose solutions. The patient is able to manage her hypoglycemia at home self-containedly and hypoglycemic coma has not developed since the insertion of the port.

Key words: dumping syndrome, postprandial hypoglycemic syndrome, somatostatin, intravenous port

Maintaining the normal glycemia in critically ill patients is one of the primary aims of the medical care. Hyperglycemia influences overall metabolism, immune system and blood coagulation. In addition to commonly used algorithms that combine continuous insulin and glucose administration, it is possible to use Glucostator to maintain the normal glycemia in critically ill patient in the intensive care. The case history presents the setting, the course of continuous monitoring and the therapy of a female patient with uncontrolled diabetes mellitus during febrile illness.

Key words: intensive care, continuous monitoring, continuous administration, Glucostator, diabetes mellitus

Combination of metformin and thiazolididione derived drugs proves to be beneficial in diabetics with significant manifestation of insulin resistance, because the effect of both types of drugs on insulin resistance is caused by different mechanism. The author presents two case histories of patients with type 2 diabetes mellitus with significant manifestation of insulin resistance who were unsatisfactorily controlled by metformine. The author pointed out that addition of thiazolididione derived drug (rosiglitazone) was not only effective but also safe. After six months of a treatment glycated hemoglobin (HbA_1c) decreased by more than 1 % (1,2 respective 1,3 %) in both patients. During a 6 moths follow-up of rosiglitazone treatment there was no significant change in body mass index, blood count, hepatic and renal parameters. In both patients the level of triglycerides decreased, HDL cholesterol increased and C-reactive protein (CRP) decreased. Rosiglitazone treatment resulted in both patients in favorable influence of other signs of metabolic syndrome.

Key words: insulin resistance, metformin, rosiglitazone, efficacy, safety

We present a case history of 26 years old male patient, treated for hypertension and suffering from Fabry’s disease with multiple organ impairment (including renal failure requiring intermittent hemodialysis). The patient was admitted to our intensive care unit for quantitative impairment of onsciousness resulting in urgent airways intubation and artificial pulmonary ventilation. The deep coma was most probably caused by the emergent hypertensive crisis.

Key words: Fabry’s disease, hypertensive encephalopathy, chronic renal failure, hyperhydratation, febrile crisis

We present a case history of a middle age male patient with mild to moderate essential hypertension who developed great number of adverse effects during antihypertensive treatment. The patient experienced the impairment of sexual function as the worst symptom. Though being aware that symptoms do not necessarily need to be caused primarily by drugs, we tried to find a combination of drugs that would be effective enough and that would result in good patient’s response even in sexual sphere. Consultation with a specialist of urology-andrology turned out to be useful.

Key words: adverse effects of antihypertensive treatment, out-patient monitoring of blood pressure, sexual dysfunction

We are describing a case history of 71 years old patient with a thyroidal neoplasm - immunohistochemically proven heterogeneous follicular and medullar carcinoma. Follicular and medullar thyroidal carcinoma has been documented in literature since 1990; nevertheless it has been very rare. Predominant opinion nowadays is that such coincidence is not accidental but in some cases it is rather caused by the effect of common oncogenic factors on different cell lines. The patient underwent the excision of melanoma in a temporal region 8 months ago and following the procedure he was treated with a long term immunotherapy consisting of interferon α. Authors believe that the presented case history supports the above mentioned conception.

Key words: medullar carcinoma, calcitonin, dually differentiated thyroidal carcinoma, interferon

The authors present a case history of a patient with destructive mandible tumor that was the initial sign of skeletal involvement caused by primary hyperparathyroidism. The hyperparathyroidism was caused by the adenoma of the left lower parathyroid gland. Full regression of the osteolytic lesions gradually followed the surgical removal of the affected parathyroid gland. The report shows that hyperparathyroidism should not be ignored in a differential diagnosis of the osteolytic skeletal involvement.

Key words: brown tumor, mandible, hyperparathyroidism, parathyroid gland adenoma

A case history presents the 64 years old female patient with hypercalcaemia. The cause of hypercalcaemia remained unknown for a long time despite of detailed examination. In this case the suspicion of paraneoplastic hypercalcaemia was correct, but the determination of breast cancer as a cause despite the fact that mammography did not prove the relapse was incorrect. Little attention was paid to the pathologic changes in the lesser pelvis. Gynecological examination and the imaging techniques correctly diagnosed enlarged myomatous uterus but the uterus masked the right ovarian tumor. The hypercalcaemia was most probably really caused by the pathologic secretion of PTHrP (parathormone related peptide) by the ovarian carcinoma. The genetic examination, that was performed because of the tumor duplicity of breast and ovarian carcinoma, did not prove BRCA 1 or BRCA 2 mutation.

Key words: hypercalcaemia, parathormone, PTHrP, ovarian carcinoma, BRCA