Decreased ability of high density lipoproteins to transfer cholesterol esters in non-insulin-dependent diabetes mellitus

Abstract. Esterified cholesterol transfer (ECT) from high density lipoproteins (HDL) to very low (VLDL) and low density lipoproteins (LDL) may be abnormal in situations at high risk for atherosclerosis. It has been shown to increase in insulin-dependent diabetes and to decrease in non-insulin-dependent diabetes (NIDD). Since the net transfer of esterified cholesterol (EC) results from a bidirectional exchange between HDL and VLDL/LDL, we developed a transfer assay specifically designed to measure the unidirectional transfer of EC from HDL to lipid emulsions according to first-order kinetics. Our results show that in NIDD the rate constant of HDL-dependent ECT is decreased by 30% by comparison with control subjects. Analysis of HDL composition revealed that, in both groups, HDL-dependent ECT was positively correlated with the free cholesterol/phospholipid ratio (r = 0^.94; P < 0.001) and negatively correlated with the triglycer-ide/EC ratio (r=-0.85; P<0.001). It is concluded that, besides the known defect of acceptor lipoproteins, the abnormality of ECT in NIDD is also caused by a decreased ability of HDL to act as an EC donor, presumably because of a change in composition. In addition, our work shows that the amount of EC lost by HDL during the reaction transfer is counterbalanced by a reciprocal equimolar transfer of triglycer-ides.     

BRAIN GROWTH IN CHILDREN WITH KWASHIORKOR A Study using Head Circumference Measurement, Transillumination und Ultrasonic Echo Ventriculography

ABSTRACT. Engsner, G., Habte, D., Sjögren, 1. and Vahlquist, B. (Ethiopian Nutrition Institute and the Ethio-Swedish Pediatric Clinic, Addis Ababa, Ethiopia, and the Department of Paediatrics, University Hospital, Uppsala, Sweden). Brain growth in children with kwashiorkor. A study using head circumference measurement, transillumination and ultrasonic echo ventriculography. Acta Paediatr Scand, 63, 1974.—Brain growth was studied in 53 children with kwashiorkor and marasmic kwashiorkor by the simultaneous use of head circumference measurement, transillumination and ultrasonic echo ventriculography. The results of examinations on admission showed that the head circumference was reduced but probably slightly less so than in marasmic children. The transillumination findings were distinctly abnormal: bearing the age difference in mind, the abnormality was more pronounced than in the cases of marasmus. The lateral ventricle index, calculated from echo ventriculograms, was increased, which was not the case in marasmus. A systematic follow-up study for 6 months of 10 patients showed a gradual and complete normalization of the transillumination and echo ventriculographic findings. The interpretation of the results, taking into consideration also the possible sources of error, is discussed.     

Neonatal aortic arch thrombosis

An infant presented shortly after birth with signs suggestive of aortic coarctation. Echocardiography revealed an extensive aortic arch thrombus, not amenable to surgery. Thrombolytic agents reduced thrombus size, enabling survival, but failed to prevent neurological damage secondary to cerebral embolisation.     

CASE REPORT: Cytomegalovirus infection as a cause of acute portal vein thrombosis

We report on the case of a 31-year-old woman who developed acute portal vein thrombosis during the course of an acute cytomegalovirus (CMV) infection. We suggest a relationship between CMV infection, its endothelial cell-damaging effects and portal vein thrombosis.     

Effects of 1% chlorhexidine gel treatment on sympathetic adrenergic nerves in human buccal mucosa

The effect of treatment with a commercially available 1 % chlorhexidine gel (Hibitane Dental) in custom trays for 14 days (10 min daily) on the sympathetic adrenergic nerves in biopsies from human buccal mucosa was investigated. Chemical assay of endogenous noradrenaline concentration and immunocytochemical demonstration of tyrosine hydroxylase served as markers for structural and functional integrity of the adrenergic nerves. The mean concentration of noradrenaline in chlorhexidine treated tissues did not differ from the mean concentration in control. No morphologic or fluorescence intensity differences of the tyrosine hydroxylase immunoreactivity were found in the chlorhexidine treated tissues when compared to controls. These findings indicate that a relatively intense treatment with a commercially available 1% chlorhexidine gel does not affect the adrenergic innervation of human buccal mucosa.     

Giant thrombosed aneurysm associated with an arteriovenous malformation: Case report and review of the literature

The association of cerebral arteriovenous malformations and intracranial aneurysms has been well documented. Among these are a subset of giant aneurysms in association with arteriovenous malformations which are relatively rare. We present a case report and a brief review of the literature regarding this entity.     

Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa

Aims: To describe the practice of pediatric anesthesia in the main University Hospitals in Benin. Patients and Methods: We conduct a retrospective study involving 512 children at the ‘Centre National Hospitalier et Universitaire’ and the ‘Hôpital de la Mère et de l’Enfant Lagune’ in Cotonou. All children less than 15 years of age undergoing surgery from January to December 2007 were included. Patient demographics, anesthetic technique, perioperative monitoring and complications were analyzed. Results: General anesthesia was used in 94% of children. Regional anesthesia was used in 1.7% of children at CNHU and 17% of children at Hôpital de la Mère et de l’Enfant Lagune. Inhalational induction was the commonest technique used. Halothane was the only inhalational agent available for induction. Seventy‐two percent of children having general anesthesia were intubated. Muscle relaxation was used in 48% of cases, only with pancuronium. The available perioperative monitoring equipment was not used regularly. All children having general anesthesia breathed spontaneously with manual assistance. There were eight cardiac arrests recorded, giving an incidence of 156 cardiac arrests per 10 000 anesthetics. Hypoxia was the commonest cause of cardiac arrest. The mortality associated with cardiac arrest was very high (62%). There were three prognostic factors that predicted a poor outcome: age <1 year, emergency surgery and an ASA score of three or more. Conclusion: Pediatric anesthesia in the two University Hospitals is far from satisfactory. Morbidity and mortality are unacceptably high. Suggestions are made to improve the safety of children undergoing anesthesia.