Hypertriglyceridemia—Acute Pancreatitis—Ischemic Heart Disease

ABSTRACT Hyperlipoproteinemia type V, with serum triglyceride concentrations of about 20 mmol/1, was detected in a pair of monozygotic, 40-year-old twin brothers. One of them had had recurrent attacks of pancreatitis, the other not. The endocrine and exocrine pancreatic functions were apparently normal, supporting that the pancreatitis was secondary to the hypertriglyceridemia. After successful lipid-lowering therapy the attacks of abdominal pain disappeared and remained absent during a 13-year follow-up period. The other twin died of ischemic heart disease nine years after the discovery of his lipid abnormality. The reduction of his lipid levels had been much less successful. His average “atherogenic index” (the ratio of cholesterol in low density to that in high density lipoproteins) was normal but increased to a very high value if cholesterol in very low density lipoproteins was also included together with the low density ones in the numerator. Lipoprotein particles modified in composition may have contributed to an increased uptake through a scavenger pathway and promoted atherosclerosis.     

Fultility—futilis—The Leaky Vessel

[Schmidt T. Futility—futilis —the leaky vessel. Ann Emerg Med . June 2000;35:615-617.]     

Bring the old boys—and girls—Back home

• What the article teaches. Patients who are not discharged home after transcatheter aortic valve replacement have higher mortality during follow‐up
• How it will impact practice. Implementation of hospital protocols aimed at reducing rates of un‐necessary nonhome discharge is desirable.
• What new research/study would help answer the question posed. The reasons for worse outcomes after nonhome discharge should be further investigated, as well as the cause of higher likelihood of nonhome discharge in some patients' subgroups, like women.

     

Colonoscopic Diagnosis of Typhoid Fever: —A Case Report—

Abstract: A case of typhoid fever was studied colonoscopically. Several scattered ulcers were observed at the ileocecal area and the course of their healing was followed by colonoscopic examination. The ulcers were discrete and punched out in appearance. Chloramphenieol was administrated, and the ulcers were observed to gradually diminish in size and number     

Endoscopic Findings of Primary Sclerosing Cholangitis—-Report of a Case—

Abstract: A case of primary sclerosing cholangitis in which an endoscopic inspection through the fistula produced by percutaneous transhepatic biliary drainage was performed for the treatment of progressive jaundice and supprative cholangitis is presented. These treatments benefited the patient to some degree. After 3 years from the onset, the patient died of multi-organ failure caused by disseminated intravascular coagulopathy. An autopsy revealed primary sclerosing cholangitis. No evidence of ductal stricture due to malignancy or underlying cholelithiasis was noted. This report may be the first which discusses the endoscopic findings of a biliary tract stricture in a patient with sclerosing cholangitis.     

Prenatal methamphetamine—impact on the mother and child—a review

Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug-using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co-existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid-centric with little attention paid to the consequences of prenatal MA exposure.     

Portal Hypertensive Colopathy —Endoscopic,Hernodynamic and Morphometric Study—

Abstract: Although it is widely accepted that congestive gastropathy is a well recognized manifestation of portal hypertension, the influence of the latter on the lower gastrointestinal tract has not been adequately studied. Therefore, we evaluated prospectively, by total colonoscopy, 30 consecutive cirrhotic patients after their varices were obliterated by endoscopic sclerotherapy. All of them had not had any bleeding episode for some time and all had varying degrees of congestive gastropathy identified by an UGI endoscopy at the time of the study. Additionally, colonic mucosal perfusion was assessed by means of laser-Doppler flowmetry at 4 defined points on the transverse colon and two mucosal biopsy specimens were obtained from the same area for histology and morphometric analysis of mucosal capillaries. Seven non cirrhotic patients who had undergone colonoscopy for various reasons but had no findings, served as controls. Twenty-eight patients [rate 93%] were found to have multiple vascular ectasis of differing degrees of severity. These vascular-looking lesions were mainly located in the right colon and rectosigmoid. Less frequent lesions were non specific mucosal edema, sparse mucosal veins and rectal varices. The statistical evaluation of mucosal perfusion revealed a highly significant decrease of blood flow in the cirrhotic patients [p = 0.00001]. A morphometric analysis revealed a significantly higher mean number of capillaries [p = 0.0012] and a higher mean cross-sectional vascular area per field in the cirrhotic patients than in the control subjects [p=0.0055]. We concluded that portal hypertension affects the lower gastrointestinal tract giving an endoscopic, microcirculatory and histopathologic pattern quite similar to that of the gastric mucosa.     

Blood Pressure in Relation to the Renin—Angiotensin—Aldosterone System

ABSTRACT. The relationship between blood pressure (BP) and the renin—angiotensin—aldosterone system was studied in a stratified random sample (n = 120) of 49-year-old men selected from a BP screening and covering a wide range of BPs. Only subjects not on antihypertensive treatment were included. None had malignant or secondary hypertension. Plasma renin activity, plasma concentrations of angiotensin II, aldosterone, sodium, potassium and noradrenaline and the 24-hour urinary excretions of sodium, cortisol and noradrenaline were determined. Of these variables, only p-aldosterone was significantly correlated with BP, both in the whole study group (R=0.22, p<0.02, n = 119) and in the subjects with the highest BP range (R =0.36, p<0.02, n=30). Of the clinical groups compared, the hypertensive subjects had significantly higher mean p-aldosterone than the borderline and normo-tensive subjects. Multiple regression analysis showed that the 24-hour urinary excretion of noradrenaline was the factor most strongly correlated to p-aldosterone, suggesting that the sympathetic nervous system might stimulate aldosterone secretion. Our findings indicate that aldosterone may be of importance for the development and maintenance of essential hypertension.     

Zymosan—Induced Arthritis

Zymosan particles, which are able to activate complement by the alternative pathway and to induce enzyme secretion from macrophages, were injected into knee joints of mice. After various time intervals, synovia were assessed histologically for various markers of inflammation. Within 7 days after intraarticular injection of zymosan, a chronic inflammatory arthritis with mononuclear cell infiltration, synovial hypertrophy and pannus formation was observed. Latex particles, which do not activate complement or macrophages, produced only mild, transient inflammatory reactions.