Primary prevention of coronary artery disease through a family-oriented cardiac risk factor clinic

Primary prevention of coronary artery disease in children and young adults is important and can be instituted through a family-oriented cardiac risk factor clinic. Such a clinic was initiated at the Medical College of Georgia in March 1988. Children whose total cholesterol level (TC) exceeded 200 mg/dL when screened by their primary care physician were referred with their siblings and parents for fasting lipid profile and further evaluation. Data are available for the initial 21 families, including 30 children and 36 adults. The mean TC level was 258 mg/dL for index cases, 195 mg/dL for siblings, and 233 mg/dL for parents. Follow-up data obtained after therapy at a mean of 6 months are available for 12 families, including 14 children and 14 adults. The mean change in TC was from 265 to 246 mg/dL; 82% of the patients had a decrease in TC. Only one index case was documented as having neither a sibling nor a parent with an elevated cholesterol level. Family-oriented cardiac risk factor clinics are important for the identification and treatment of hypercholesterolemia in asymptomatic young people when primary prevention is possible.     

Duodenal leiomyoma as a cause of gastrointestinal hemorrhage.

A case report and review of the problem of duodenal leiomyoma are presented. Although these lesions are rare and usually asymptomatic, they can present with symptoms of hemorrhage, obstruction, pain, and perforation. Barium roentgenographic examination may show filling defects of compressive lesions. Angiography shows a hypervascular, encapsulated lesion. Endoscopy may reveal a submucosal mass with central depression. At operation, it is important to distinguish the benign leiomyoma from leiomyosarcoma.     

Inhibition by ranitidine of acetaminophen conjugation and its possible role in ranitidine potentiation of acetaminophen-induced hepatotoxicity

Pretreatment with ranitidine (RA) potentiates the hepatotoxicity of acetaminophen (APAP) in male Fischer 344 rats. The present studies were undertaken to investigate the role of APAP metabolism in this potentiation. Administration of RA (50 mg/kg p.o.) to male Fischer 344 rats 30 min before [3H]APAP (750 mg/kg p.o.) increased the plasma concentrations of acetaminophen at 2 hr (193%) and 4 hr (277%) after APAP. Covalent binding of [3H]APAP-related material to hepatic macromolecules in RA-pretreated animals was similar to APAP alone values up to 12 hr after treatment; however, 24 hr after APAP, binding in the RA-pretreated animals was twice that observed in animals given [3H]APAP alone. Urinary excretion (0-24 hr) of APAP and APAP glucuronide were reduced in ranitidine-pretreated animals to 64 and 66% of control, respectively, indicating that in vivo RA altered APAP conjugation with glucuronic acid. APAP uridine diphosphoglucuronyltransferase activity in rat hepatic microsomes was competitively inhibited by RA (0.1-2 mM). The Ki apparent for RA inhibition of APAP uridine diphosphoglucuronyltransferase was 0.04 mM. In contrast, neither APAP nor 4-nitrophenol sulfotransferase activity in rat hepatic cytosol was inhibited by RA at concentrations up to 5 mM. Together, these results support the suggestion that RA-mediated alterations of APAP conjugation may explain the potentiation of APAP-induced hepatotoxicity by RA in rats.     

Intracranial granulocytic sarcoma in postpolycythemia myeloid metaplasia

A 57-year-old man with a ten-year history of polycythemia vera had myeloid metaplasia, extramedullary hematopoiesis, and terminally, possible leukemic transformation with intracranial granulocytic sarcoma. Radiation therapy produced a partial and temporary beneficial response. Intracranial granulocytic sarcoma is typically associated with acute or chronic myelogenous leukemia and has not been previously associated with postpolycythemia myeloid metaplasia.     

Medical therapy in Crohn's disease.

Traditionally, sulfasalazine and corticosteroids have been used to treat Crohn's disease. However, therapy has been expanded to include other drugs, and several newer agents show clinical promise. The authors discuss the therapeutic options now available and describe results of several drug trials. Despite the apparent benefits of newer therapies, caution must be used in choosing appropriate treatment.