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Marek Czarkowski

Publications and source records attributed to Marek Czarkowski.

10 recordsLinked to original sources
PubMed2006

The protection of patients' rights in clinical trials.

The Helsinki Declaration is a very important document regarding the protection of patients' rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients' rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients' rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting.

Clinical Trials as Topic↗
PubMed2006

[Standard operating procedures in ethic committees].

Polish ethic committees should have to work together in order to maintain and develop high quality standards in the protection of human subjects. Exchanging knowledge, know-how and information polish ethic committees should have to implement standard operating procedures. Procedures should improve quality and proficiency of all types of ethic committee's activities. Standard operating procedures should cover as important problems as conflict of interest, trial's insurance or elections of ethic committees. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. Governmental initiatives and creation of forum for polish ethic committees are essential in the effective standardisation, coordination and implementation of procedures in regional ethic committees. These projects need support via public funding from our authorities.

Conflict of Interest↗
PubMed2006

[In patients with Graves' disease signal-averaged P wave duration positively correlates with the degree of thyrotoxicosis].

Coexistence of the goitre, proptosis and palpitations was observed in XIX century for the first time. Sinus tachyarytmias and atrial fibrillation are typical cardiac symptoms of hyperthyroidism. Atrial fibrillation occurs more often in patients with toxic goiter than in young patients with Grave's disease. These findings suggest that causes of atrial fibrillation might be multifactorial in the elderly. The aims of our study were to evaluate correlations between the parameters of atrial signal averaged ECG (SAECG) and the serum concentration of thyroid free hormones. 25 patient with untreated Grave's disease (G-B) (age 29,6 +/- 9,0 y.o.) and 26 control patients (age 29,3 +/- 6,9 y.o.) were enrolled to our study. None of them had history of atrial fibrillation what was confirmed by 24-hour ECG Holter monitoring. The serum fT3, fT4, TSH were determined in the venous blood by the immunoenzymatic method. Atrial SAECG recording with filtration by zero phase Butterworth filter (45-150 Hz) was done in all subjects. The duration of atrial vector magnitude (hfP) and root meat square of terminal 20ms of atrial vector magnitude (RMS20) were analysed. There were no significant differences in values of SAECG parameters (hfP, RMS20) between investigated groups. The positive correlation between hfP and serum fT3 concentration in group G-B was observed (Spearman's correlation coefficient R = 0.462, p < 0.02). No significant correlations were found between RMS20 and serum fT3 in G-B group and between hfP or RMS 20 and serum fT3 in group K. These findings suggest that occurrence of atrial fibrillation in patients with Grave's disease depends not only on hyperthyroidism but on serum concentration of fT3 also.

Adult↗
PubMed2005

[Mean arterial blood flow depends on the intensity of thyrotoxicosis in patients with Graves' disease].

UNLABELLED: Thyrotoxicosis leads to profound changes in the cardiovascular system. AIM: Using a new non-invasive ultrasonic system VED elaborated by Powałowski et al., we aimed to assess whether arterial blood flow is related to the intensity of thyrotoxicosis in patients with Graves' disease. MATERIAL AND METHODS: We compared two groups: hyperthyroid (Graves' group n=25, mean age=31+/-8 years) and euthyroid (control group n=23, mean age 30+/-7 years). Mean arterial blood flow (Q) was determined in the common carotid artery on the basis of ultrasound continuous wave Doppler and echo examinations. RESULTS: Q was significantly higher in the Graves'group: 11.52+/-4.36 vs 8.33+/-2.02 10(-6) m3/s, p<0.00003. There was positive correlation between Q and blood concentrations of thyroid hormone in the Graves' group (rS=0.5372, p<0.00001 for Q and fT3; rS=0.4087, p<0.005 for Q and fT4). No correlation between Q and age nor Q and lipid parameters (total cholesterol, HDL-cholesterol nor LDL-cholesterol) were found in the Graves' group. CONCLUSION: In thyrotoxic patients with Graves' disease there is not only a qualitative but also a quantitative relationship between thyroid hormone and blood flow in the common carotid artery.

Adult↗
PubMed2005

[Acute hypercalcaemic crisis in the course of PTH-rP producing squamous cell carcinoma of the skin--a case report].

Hypercalcemia is one of the most common paraneoplastic syndromes, where it may result from the presence of osteolytic metastases or from humoral effect of factors produced by tumor cells. One of such factors is the parathyroid hormone-related protein (PTH-rP). This protein is usually produced by solid tumors, especially by squamous cell carcinomas. In the case of squamous cell carcinoma of the skin hypercalcemia is very rare and symptomatic hypercalcemia is unusual. We present a case of acute hypercalcemic crisis as a consequence of overproduction of PTH-rP in a patient with spinocellular squamous cell carcinoma of the skin, which was proved by immunohistochemical staining of the tissue samples from the neoplastic lesion, metastases in bone and in lung, and also from kidney and liver.

Acute Disease↗
PubMed2005

[Transient hyponatremia the first symptome of multiple endocrine neoplasia type 1 (MEN 1)--case report].

Transient character of laboratory abnormalities is usually explained as a false result of estimation. Spontaneous disappearance of laboratory abnormalities could be recognized as non-important and contradicting serious disease. Presented case of multiple endocrine neoplasia type 1 (MEN 1) denies these assumptions. Sixty-nine-years old woma was admitted to the internal department because of weakness, fever, dehydration and hypotension--symptom accompanying an upper respiratory infection. Moderate hyponatremia (122.6 mmol/l) was found in a routine laborator examination. All clinical symptoms as well as hyponatremia disappeared during hospitalization. Transient hyponatremi was not ignored. Further laboratory and hormonal investigations were performed. Fasting, morning serum cortisol concentration and 24-hours urinary excretion of free corticosterids were decreased and Synacten stimulation test reveale incomplete cortisol stimulation. Pituitary tumour was found in the CT scan. Moreover blood ionized calcium an parathyroid hormone were elevated. These results revealed secondary adrenal insufficiency, non-functioning pituitary tumor and hyperparathyroidism. Removal of pituitary adenoma was done. Asymptomatic hypercalcemia persists. Presented MEN 1 was atypical because: 1. Usually hyperparathyroidism is the first and most frequent symptom while in our patient the first symptom was transient hyponatremia secondary to the pituitary tumor, 2. was diagnosed in the old age while the majority of MEN 1 patients are younger, 3. asymptomatic course of hypercalcemia indicates that in some of elder patients removal of the parathyroid glands might not be necessary.

Aged↗
PubMed2004

Venous blood redistribution alters the accuracy of Omron HEM-705CP.

BACKGROUND: Validation procedures of automated blood pressure measuring devices are carried out at rest only. DESIGN: We aimed to determine whether venous blood redistribution affects the accuracy of the OMRON HEM-705CP (Osc). Lower body negative pressure stimulus (-40 mmHg) (LBNP) was used to simulate changes of body position. METHODS: Fifty-four young healthy volunteers had their blood pressure (BP) measured simultaneously by Osc and mercury sphygmomanometer (HgS) at rest (at 3 and 5 min) and during LBNP (at 7 and 9 min). RESULTS: Differences (delta) between HgS and Osc for systolic and diastolic BP (SBP and DBP) were calculated. The deltaSBP obtained in minute 9 (deltaSBP-9) was bigger than the one taken in minute 5(deltaSBP-5) (-2.89+/- 4.3 versus -1.35+/-5.2 mmHg, P<0.02). The rest of the deltaSBP values and all the deltaDBP values were constant at rest and during venous blood redistribution caused by LBNP. We calculated the fall in SBP separately for HgS and Osc by subtracting SBP-9 from SBP-5 for each patient. The fall measured by Osc was bigger than by HgS (-5.87+/-4.0 versus -4.3+/-4.5 mmHg; P<0.02). When graded according to British Hypertension Society protocol, Osc remained in the class of recommendation (A or B) for every minute of the procedure. CONCLUSIONS: Even if an oscillometric device passes various validation tests, they do not give sufficient information about its accuracy during venous blood redistribution. This knowledge is of particular importance when BP regulation abnormalities occurring during changes in body position are diagnosed with the oscillometric method.

Adult↗
PubMed2003

Accuracy of SpaceLabs 90207 is altered by venous blood redistribution.

Validation protocols that have been introduced for automated blood pressure (BP) measuring devices recommend procedures carried out at rest only. We aimed to determine whether venous blood redistribution affects the accuracy of the oscillometric method of BP measurement. For this purpose, we chose a popular oscillometric ambulatory BP monitor--the SpaceLabs 90207 (Osc). Lower body negative pressure (-40 mmHg) (LBNP) was used to simulate changes of body position. Fifty-one young healthy volunteers had their BP measured simultaneously by Osc and mercury sphygmomanometer (HgS) at rest (min 3 and 5), during LBNP (min 7 and 9) and after LBNP (min 11). Differences (delta, mmHg) between HgS and Osc for systolic (SBP) and diastolic BP (DBP) were calculated for every measurement minute. For SBP, deltaSBP-7 and deltaSBP-9 were significantly different from deltaSBP-5 (0.65 +/- 2.6 and 0.33 +/- 2.4 mmHg vs -0.80 +/- 2.9 mmHg, p < 0.003 and p < 0.02, respectively). deltaSBP-11 also differed significantly from deltaSBP-3 and deltaSBP-5 (1.16 +/- 2.5 mmHg vs -0.06 +/- 3.1 mmHg and -0.80 +/- 2.9, p < 0.01 and p < 0.00007, respectively). When graded according to British Hypertension Society protocol, Osc remained in the A class in every measurement minute. The accuracy of SpaceLabs 90207 is altered by venous blood redistribution. These inaccuracies may constitute an additional limitation of oscillometric ambulatory BP monitoring.

Adult↗
PubMed2002

[Low-symptomatic pheochromocytoma].

We present the patient with 1-month history of mild hypertension, who was admitted to our department with suspicion of coronary heart disease. He had family history of hypertension and coronary heart disease, hyperlipidaemia and he has been smoker for several years. During the diagnostic exertion test chest pain together with an unusual high blood pressure was found (240/140 mmHg). The results of catecholamines and their metabolites in 24-urine collection, abdominal ultrasonography and NMR revealed pheochromocytoma in the left adrenal gland, which was removed successfully. Particular clinical examination allowed to include the patient to the group with low-symptomatic pheochromocytoma. Abdominal USG, which had been done prior to the exertion test, didn't reveal any incidental tumor in the adrenal glands. The abnormal hypertensive reaction during exertion test was the main decision of the urine catecholamines and their metabolites determination. Pheochromocytoma should be included to the differential diagnosis in all patients with chest pain and high blood pressure during diagnostic exertion test.

Adrenal Gland Neoplasms↗