High density lipoprotein cholesterol and triglycerides as markers of angiographically assessed coronary artery disease

Serum triglycerides, high density lipoprotein (HDL) cholesterol, and total cholesterol were measured in 698 patients examined by angiography. The ratio of HDL cholesterol to total cholesterol was significantly lower in patients with single, double, and triple vessel disease than in patients without disease. The serum concentration of triglyceride was significantly higher in patients with single, double, and triple vessel disease than in those without coronary artery disease. Similar proportion of patients with coronary artery disease and without had serum cholesterol concentrations of greater than or equal to 6.5 mmol/l, but total cholesterol was significantly higher in patients with single, double, and triple vessel disease than in those without. HDL cholesterol (less than 1.0 mmol/l), triglycerides (greater than 2.0 mmol/l), and the ratio of HDL cholesterol to total cholesterol (less than 0.20) were significantly better than total cholesterol as indicators of coronary risk.     

Evolution of gastritis in patients with gastric erosions

Objective. Gastric erosions are mainly associated with Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs), but there has been no information available on the long-term evolution of gastritis in subjects with erosions. Material and methods. A series of 117 patients with gastric erosions without peptic ulcer disease and matched controls without erosions or ulcers were studied. Available subjects underwent endoscopy and biopsy 17 years later. Parietal cell antibodies were analysed at the first visit. Results. Fifty-two patients and 67 controls were available for follow-up. Since H. pylori was a major determinant of gastritis, only subjects with unchanged H. pylori status were included in the evaluation of gastritis progression. At the follow-up visit, gastric erosions were present in 38% (16/42) of the patients and 11% (5/46) of the controls (p=0.005). In H. pylori-negative subjects, no evolution of histological changes was seen. In H. pylori-positive subjects, body gastritis was initially less active in the erosion group. With time, antral gastritis worsened only in the erosion group. Parietal cell antibodies were more common in the control group (23%; erosion patients 0%; p=0.01), which also showed worsening of gastritis (p=0.003) and aggravation of atrophy (p=0.002) in the body mucosa. Conclusions. Gastritis in H. pylori-positive subjects with gastric erosions shows evolution of antral predominance, body predominance including development of atrophic changes being rare. Accordingly, patients with erosions share the characteristics of gastritis of the duodenal ulcer phenotype. These findings support the importance of H. pylori and acid in the pathogenesis of gastric erosions in H. pylori-positive patients.     

Duodenogastric Bile Reflux in Patients with Gastric Ulcer

The duodenogastric bile reflux rate in 33 patients with gastric ulcer is compared with the rates in 33 non-ulcer patients. Duodenogastric bile reflux was measured by a non-invasive isotope method using ^99mTc-diethyliminodiacetic acid. Reflux occurred significantly oftener in the ulcer patients (27 of 33) than in the non-ulcer patients (14 of 33) (p < 0.01) but did not differ significantly in quantity between these two groups. The results suggest that the magnitude of bile reflux cannot be used to distinguish between ulcer patients and non-ulcer patients.     

Early invasive therapy of non ST-elevation acute coronary syndromes--combined with upstream antiplatelet therapy: yes--but how early?

See doi:10.1016/S1095-668X(03)00259-8for the article to whichthis editorial refers The increasing number of patients with non ST-elevation acutecoronary syndromes (ACS) is placing an enormous economic burdenon health care in Western countries. Recently updated Europeanand American guidelines have clarified the recommendations forhow these patients should be treated.^1,2The well-conducted FRISCII trial strongly suggested the superiority of early invasivestrategy compared to a more watchful ‘wait-and-see’conservative strategy.³These observations were further confirmedby the TACTICS–TIMI 18 trial,⁴where early invasive strategywith an adjunctive upstream glycoprotein (GP) 2b/3a inhibitorfrom 4 to 48h (median 22h) before the intervention appearedto result in     

Relationship ofcampylobacter pylori and duodenogastric reflux

We have examined the relationship of Campylobacter -like organism (CLO) and duodenogastric reflux (DGR) in 107 patients with unoperated stomachs. Neither the extent of externally measured bile reflux nor the concentrations of bile acids or lysolecithin in the gastric fluid differed significantly in the groups with different numbers of CLO in the gastric mucosa. Our results suggest that DGR, in the quantities commonly present in unoperated stomachs, does not effect the presence of C. pyloriin the gastric mucosa.     

Functional evaluation after aortic valve replacement

Preoperative and sequential postoperative bicycle exercise tests were compared with clinical and catheterization data in assessment of the functional outcome of uncomplicated aortic valve replacement (AVR) in 33 patients. The operation was done because of aortic stenosis (AS) in 14 patients and aortic regurgitation (AR) in 19. Both groups of patients showed improved NYHA functional class and peak achieved workload after AVR, but the results in these respects did not correlate. Nor did the regression in left ventricular (LV) hypertrophy and dilatation after AVR that was seen in both patient groups correlate with the changes measured in exercise tolerance. Preoperative exercise capacity was not predictive of the postoperative performance. In the AR patients, however, preoperative ability to raise the systolic blood pressure during exercise appeared to predict which patients were likely to show enhanced resting LV systolic pump function after AVR. It is concluded that objective tests of exercise tolerance alone permit reliable evaluation of the functional outcome of uncomplicated AVR. Indices of resting LV performance, though helpful in observation of the changes resulting from removal of the untoward LV burden after AVR, are likely to be less useful for evaluating changes in the LV exercise reserve. The response of the systolic blood pressure to exercise may be an additional predictive factor for postoperative resting LV performance in patients with AR.     

Attenuated yaws in Surinam.

Results of a pilot survey in the central, northern region of Surinam indicate that yaws is prevalent (hypoendemic) in this part of the country. No classical symptoms of yaws were seen. The observed lesions were scanty or solitary, dry papillomatous, or macular and scaly, which fits into the clinical picture of attenuated endemic treponematosis.     

Additive effects of moderate drinking and obesity on serum gamma-glutamyl transferase activity

BACKGROUND: Gamma-glutamyl transferase (GGT) is a widely used index of liver induction and a marker of alcohol overconsumption. Obesity has also been suggested to elevate serum GGT activities. OBJECTIVE: The aim was to examine the links between moderate ethanol consumption, obesity, and GGT activities. DESIGN: GGT values were recorded from 2490 persons (1184 men and 1306 women) who reported either no alcohol use (abstainers) or 1-40 g ethanol consumption per day (moderate drinkers). The study population was additionally classified according to body mass index (BMI; in kg/m2) as follows: < 19 (underweight), > or = 19 and < 25 (normal weight), > or = 25 and < 30 (overweight), and 30 (obese). RESULTS: Significant main effects of sex (P < 0.0001), drinking habits (P < 0.01), and BMI (P < 0.001) on serum GGT activities were observed. The values were higher in the men than in the women and higher in those with higher BMIs. The highest activities were found to occur in persons with moderate drinking combined with overweight or obesity. A significant positive correlation between GGT and BMI (P < 0.0001) was observed, which was stronger for the men (r = 0.24) than for the women (r = 0.15, P < 0.05 for the difference between correlations). CONCLUSION: The data indicate that serum GGT activities may respond to moderate drinking and overweight in an additive manner; this should be considered in the clinical use of GGT measurements and when defining normal GGT values in health care.