Lecithin: cholesterol-acyltransferase (LCAT) activity in alcoholic liver disease

The activity of LCAT (the controlling enzyme for cholesterol esterification in plasma) is known to be reduced in alcoholic cirrhosis, while little is known about early stage (liver steatosis) alcoholics. In this study, LCAT activity was assayed by Stokke and Norum's method, before and after a 15-day sobriety period, in liver steatosis and in cirrhosis alcoholics. Before alcohol withdrawal, LCAT activity was depressed in both groups. After the sobriety period, LCAT activity was significantly raised in liver steatosis patients, but was still lower than in controls; in cirrhosis patients, it was increased, but not significantly. According to our results, LCAT activity impairment in alcoholic liver disease is sustained by both the hypothesized mechanisms, alcohol-related metabolic disorders and lowered LCAT-enzyme production, but to different degrees, depending on the stage of the disease. In liver steatosis, metabolic disorders play a major role, as a liver-impairment-induced decrease in LCAT production seems rather unlikely, and increased LCAT activity is more likely to be sustained by metabolic normalisation than by any recovery of the damaged liver. However, the lack of improvement in about 20% of patients, and the fairly wide scattering of individual data, suggest a minor LCAT production impairment in liver steatosis too. In cirrhosis, the major role seems to be played by a permanent decrease in LCAT production, as no significant rise in LCAT activity was observed after alcohol withdrawal. However the restored LCAT activity observed in some patients could be related to improvement in the metabolic disorder, thus confirming the effectiveness of this mechnism in cirrhosis too.(ABSTRACT TRUNCATED AT 250 WORDS)     

Concomitants of excess coronary deaths--major risk factor and lifestyle findings from 10,359 men and women in the Scottish Heart Health Study

The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10,359 men and women aged 40-59 years, in 22 districts of Scotland. The study was conducted during 1984-86, when Scotland had the highest national coronary heart disease mortality reported by the World Health Organisation. A self-completed questionnaire, complemented by a 40 minute visit to a survey clinic, staffed by nurses, enabled the classical major risk factors and some more newly described ones to be measured. The study emphasised quality control and representativeness, and incorporated a World Health Organisation protocol for measurement of key items to allow comparisons in place and time, and therefore also to provide a definitive baseline against which interventions can be assessed. This paper describes the overall findings. Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, lower than in British studies of the 1960s and 1970s. Mean body mass index levels, 26.1 Kg/m2 in men and 25.7 Kg/m2 in women, were not high by international standards. However, mean serum cholesterol levels were 6.4 mmol/l in men and 6.6 mmol/l in women--as high as those in previous British studies and high by international standards. Levels of high density lipoprotein cholesterol, non-fasting triglycerides and fibrinogen are also reported. Physical activity both at work and in leisure time was low.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health maintenance issues of the elderly. Nutrition

Although we are on steep learning curve as far as the exact relationship between nutrition and disease prevention is concerned, evidence is accumulating on the role of body mass index and mortality, protein deficiency and decreased ability to fight infection, effect of fiber intake on cholesterol and glucose metabolism, hyperlipidemia and atherosclerosis, and inadequate calcium intake in osteoporosis. Screening for nutritional disorders includes identifying those with risk factors of being female, black, poor, or institutionalized. Evidence of weight change, dietary idiosyncracies, nutrient deficiency, and laboratory tests can be helpful. Treatment should be tailored to the individual and be specific for suspected deficiencies. Attention to calories, protein, and calcium are paramount.     

CT evaluation of Crohn's disease: effect on patient management

CT scans from 80 consecutive patients with clinically symptomatic Crohn's disease were reviewed retrospectively to determine the effect of CT diagnosis on patient management. The initial clinical impression and any subsequent change in patient management because of the CT findings were noted. In 22 (28%) of the 80 patients, significant previously unsuspected findings led to a change in medical or surgical management. These included 12 patients with fistulae, four with abscess, two with avascular necrosis of the femoral head, two with sacral osteomyelitis, and single cases of pelvic inflammatory disease and femoral vein thrombosis.     

Bone loss and forms of tibial condylar fracture

Summary Bone loss and fracture type were determined in 358 tibial condylar fractures. Degree of osteoporosis at the knee was defined by analogy to Singh's grades of osteoporosis at the hip and to Jhamaria's classification of osteoporosis at the calcaneum: grade V — normal; grade IV — slight reduction of trabecular bone; grade III — osteoporosis, predominantly of trabecular bone; grade II — osteoporosis of trabecular and cortical bone. Five fracture types were distinguished, with the component of trabecular bone compression increasing from a to e: a — pure split fractures; b — split fractures with displacement of a piece of the articular surface; c — split compression fractures; d — local compression fractures; e — compression of a whole condyle. There was a highly significant rank correlation between the two sets of ordered categories. Fractures in osteoporotics tended to involve the lateral condyle; this is explained by the fact that crush fractures occurred more frequently at the lateral condyle. The influence of bone loss on fracture type was demonstrated to be independent of age. A clear understanding of these associations concerning three variables at a time was reached by the use of log-linear-model analysis for cross-classified qualitative data.

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Zusammenfassung Bei 358 Frakturen der proximalen Tibia wurden der röntgenologisch erkennbare Knochenschwund und die Frakturform festgestellt. Entsprechend dem Singh-Index zur Bestimmung der Osteoporose am proximalen Femur und der Klassifikation der Trabekelstruktur am Fersenbein nach Jhamaria wurden folgende Osteoporosegrade am Knie definiert: Grad V — normal, Grad IV — Spongiosastruktur leicht vermindert, Grad III — Osteoporose betrifft vorwiegend die Spongiosa, Grad II —Osteoporose von Spongiosa und Kompakta. Fünf Frakturformen wurden unterschieden, wobei das Ausmaß der Spongiosakompression von a bis e ansteigt: a — reine Spaltfrakturen, b — Spaltfrakturen mit Abscherung eines Gelenkflächenteiles, c —Spaltkompressionsfrakturen, d — Frakturen mit lokaler Kompression, e — Frakturen mit Kompression eines ganzen Kondyls. Zwischen diesen beiden Merkmalen, deren Ausprägungen Rangklassen bilden, war eine hochsignifikante Rangkorrelation nachzuweisen. Brüche osteoporotischer Knochen betrafen vermehrt den lateralen Gelenksknorren, was dadurch statistisch zu erklären war, daß dieser sich für Kompressionsfrakturen als anfälliger erwies. Die Beziehung zwischen Osteoporose und Frakturform war nicht abhängig vom Lebensalter. Solche Zusammenhange zwischen je drei Variablen konnten übersichtlich dargestellt wurden, indem die Häufigkeitstabellen durch Log-lineare Modelle interpretiert wurden.

     

Smoking patterns in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of tobacco-smoking habits in a random sample of 976 coloured subjects aged 15-64 years revealed that smoking was common, 57% of men and 41% of women being current smokers and 10.4% of men and 9.6% of women having stopped smoking. Heavy smoking prevailed, indicating by mean daily consumption of 14.2 and 13.1 cigarettes among male and female smokers respectively; only 33.5% of male and 39.6% of female smokers used less than 10 cigarettes per day. Coloured smokers smoked more heavily during the weekend. Both men and women smoked mostly filter cigarettes. Forty-four per cent of male and 49.5% of female smokers stated that they had attempted to stop smoking, mainly for health reasons. More than one-third of the participants had a positive attitude to combating smoking, particularly those with an educational level higher than Standard 7. Former smokers and heavy smokers had a significantly higher prevalence of ischaemic heart disease than the other participants. Smoking was associated with a low body mass index, low high-density lipoprotein cholesterol levels, low socio-economic standing, high alcohol consumption and type A coronary-prone behaviour in men. In 1982 the economically active coloured population of the Cape Peninsula spent an estimated R36.2 million on cigarettes.     

Adenocarcinoma of the lower esophagus. A disease primarily of white men with Barrett's esophagus

Sex and racial predilection, social history, and histology were analyzed in a biopsy-proven adenocarcinoma of the lower esophagus/esophagogastric junction collected over a 5-year period in two teaching institutions with different patient populations. Adenocarcinoma occurred in 11% of patients with biopsy-proven esophageal cancer. The disease occurred only in males at one center, and in a 7:1 ratio of males to females at the other center. Clear racial predilection was seen, since 12 of 13 patients with adenocarcinoma of the esophagus were white, whereas less than 20% of patients with squamous carcinoma of the esophagus were white. The finding of Barrett's epithelium in eight of the 13 cases strongly supports the theory that in white males, Barrett's epithelium is a precursor lesion of adenocarcinoma of the esophagus/esophagogastric junction.     

Benefits and risks of nonsteroidal antiinflammatory drugs in steroid-resistant nephrotic syndrome

In this paper we discuss the effects of nonsteroidal antiinflammatory drugs on proteinuria and the specific risks of these drugs in patients with nephrotic syndrome. We summarize the results of a prospective uncontrolled trial of meclofenamate in severe steroid-resistant nephrotic syndrome secondary to focal glomerular sclerosis and idiopathic membranous nephropathy. This study examined the effect of meclofenamate on proteinuria, serum albumin levels, serum cholesterol, serum triglycerides, renal function, BP, liver function tests, and hematologic values. We also sought and evaluated adverse reactions due to this medication. We offer some suggestions for selective use and careful supervision of NSAIDs in the nephrotic syndrome.