Biomedical subjects
Publications and source records attributed to J Pedro-Botet.
Amoxycillin/clavulanic acid liver injury is very rare. We describe an exceptional case of intrahepatic cholestasis without hepatitis induced by amoxycillin/clavulanic acid. Recognition of this benign cholestatic syndrome as a side-effect may obviate unnecessary complementary and costly procedures.
A 49-year-old woman presented with idiopathic bilateral diaphragmatic paralysis. The patient benefited from bilevel intermittent positive airway pressure-type assisted ventilation with rapid, excellent and long-lasting results. This case emphasizes the need for correct diagnosis and therapeutic management, particularly with a bilevel intermittent positive airway pressure-type home ventilation technique, in idiopathic bilateral diaphragmatic paralysis.
According to the new guidelines of the National Cholesterol Education Program (NCEP) for secondary prevention in adults with evidence of coronary heart disease or other clinical atherosclerotic disease, lipoprotein analysis is required and classification is based on low density lipoprotein (LDL) cholesterol. The aim of the present study was to analyze the reliability of calculated LDL cholesterol by the Friedewald formula compared with measured LDL cholesterol after separation by ultracentrifugation in 202 male patients with extracoronary atherosclerosis (100 patients with ischemic cerebrovascular disease and 102 patients with peripheral vascular disease) and in 117 health control subjects. Calculated LDL cholesterol coincided with measured LDL cholesterol, with less than 10% error, in 118 patients (58.4%) with extracoronary atherosclerosis and in 87 controls (74.4%). Calculated LDL cholesterol was overestimated, with an error of 10% or more compared with measured LDL cholesterol, in 34.6% of patients and 22.2% of controls, and underestimated in 6.9% and 3.4% respectively. Despite a good correlation between calculated and measured LDL cholesterol, the intraclass correlation coefficients demonstrate a poor concordance between calculated and measured LDL cholesterol, both in patients and controls. The authors underline the need for caution in assessing the reliability of calculated LDL cholesterol.
At present, the biochemical mechanisms underlying lipoprotein(a) (Lp(a)) metabolism are not fully understood. We analysed sera from 202 patients with atherosclerotic disease and 109 healthy subjects as a control group to investigate the possible relationship between triglyceride-rich lipoproteins (TRL) and serum lipoprotein(a) levels. To assess the influence of apolipoprotein (apo) (a) isoforms on the Lp(a)-TRL association, the apo(a) phenotypes of 177 patients and 95 controls were included in the analysis. Patients with atherosclerotic disease showed triglyceride levels almost within the normal range. There was no significant correlation between serum Lp(a) levels and triglyceride concentrations, or between Lp(a) and TRL levels in either group. When a subset of subjects from each group with serum triglycerides above 1.7 mmol l-1 was considered, a significant negative correlation between lipid concentration of very low density lipoproteins (VLDL) and serum Lp(a) levels was found only in patients. Control subjects with triglyceride levels under or over 1.7 mmol l-1 showed similar median Lp(a) levels (0.06 gl-1), in contrast to atherosclerotic patients, in whom median Lp(a) concentration was higher in the subset with serum triglycerides under 1.7 mmol l-1 than in those with triglyceride concentration above this value (0.16 vs. 0.13 gl-1). When patients with triglyceride concentrations above 1.7 mmol l-1 were classified into quartiles according to VLDL lipid concentration, subjects with the highest quartiles showed the lowest Lp(a) median levels. Despite the dependence of the Lp(a) concentration on apo(a) size isoforms, we found no effect of apo(a) genetic polymorphism on triglyceride levels or on TRL concentrations. We conclude that the variation in TRL metabolism may constitute a source of variation in serum Lp(a) concentrations that is independent of the genetically determined apo(a) molecule size.
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Visceral involvement in HIV-negative patients with classical Kaposi's sarcoma (KS) has been described only rarely. An unusual case of a 75-year-old Jewish woman with the classical form of KS who presented with cutaneous and pulmonary involvement is presented. Results of several tests for HIV antibodies were negative.
OBJECTIVE: To assess lipids and lipoprotein composition and the relationship between lipoprotein abnormalities and urinary albumin excretion (UAE) in select type II diabetic patients with stable metabolic control. RESEARCH DESIGN AND METHODS: Fifty-five type II diabetic patients and 55 healthy control subjects both with a body mass index < 30 kg/m2 were studied. Patients were classified according to their level of UAE as normoalbuminuric (n = 37), microalbuminuric (n = 11), and macroalbuminuric (n = 7). In all cases, serum creatinine and albumin concentrations were in the normal range. RESULTS: Normoalbuminuric patients showed increased triglyceride (TG) contents in intermediate-density lipoprotein (IDL) (P < 0.01), low-density lipoprotein (LDL) (P < 0.001), and high-density lipoprotein (HDL) (P < 0.001) compared with control subjects. Lipoprotein concentration in microalbuminuric patients did not differ from that of normoalbuminuric patients. On the other hand, patients with macroalbuminuria showed a significant increase in IDL cholesterol (P < 0.01) and IDL (P < 0.01), LDL (P < 0.05), and HDL TGs (P < 0.01) compared with the other groups. Diabetic patients with nephropathy, both microalbuminuric and macroalbuminuric, tended to have higher mean lipoprotein(a) (Lp[a]) concentrations than normoalbuminuric patients and control subjects. A strongly positive correlation was observed between UAE and serum TGs (r = 0.56) and very-low-density lipoprotein (r = 0.55), IDL (r = 0.52), LDL (r = 0.54), and HDL TGs (r = 0.52). CONCLUSIONS: Lipoprotein alterations observed in diabetic patients, specifically IDL abnormalities and a tendency toward high Lp(a) levels, which are more marked in those with increased UAE, may contribute to the excess of cardiovascular disease in type II diabetic patients, particularly those with nephropathy.
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Lipoproteins, including intermediate density lipoproteins and lipoprotein(a), and apolipoproteins A-I, B, C-II, C-III and E, were studied in 13 newly-diagnosed type I diabetic patients with severe insulinopenia without dehydration or acidosis. At baseline, the main finding was a significant increase in serum triglycerides due to raised triglyceride concentrations in all lipoproteins, particularly triglyceride-rich lipoproteins. Cholesterol concentrations were slightly increased in lipoproteins and led to a significant increase in serum cholesterol. Two days after the start of insulin therapy, lipoprotein profiles had normalized except for the LDL triglyceride contents, which remained significantly increased on the fifth day of treatment. No significant modifications were observed in lipoprotein(a), apolipoproteins A-I and E concentrations throughout the study. However, serum apolipoproteins B, C-II and C-III were increased at baseline and fell to normal levels 2 days after the start of insulin therapy. On the other hand, apolipoprotein C-II/C-III ratios in high and very low density lipoprotein, showed no significant differences at baseline compared with controls, suggesting that an apolipoprotein C-II deficiency or apolipoproteins Cs imbalance can be ruled out. In conclusion, significant lipoprotein abnormalities were observed in the insulin-deficient state of type I diabetes mellitus; insulin therapy normalizes the lipoprotein profile in two days, except for low density lipoprotein triglyceride contents which remain increased at the fifth day.
BACKGROUND: The aim of this study was to determine the result of partial resection of the soft palate (SPR) as a treatment of the obstructive apnea syndrome during sleep (OASS). METHODS: Fifty-seven patients diagnosed of OASS treated with SPR were studied. The clinical and polysomnographic results prior to surgery and after 6 months were compared. RESULTS: Prior to SPR the 57 patients had a mean index of apnea plus hypopnea per hour of 57 (IAH) and following surgery the same was of 19.2 (p < 0.0001). IAH improved more than 50% in 42 patients (74%), 30 of whom were cured (IAH < or = 10). Daily hypersomnia and snoring disappeared in 58% of the patients and decreased in intensity in most of the remaining cases. The secondary effects observed following SPR were: rhinolalia, nasal fluid reflux, and oropharyngeal disturbances, being present in 32 patients (56%) and permanent, although slight, in only 13 (23%). CONCLUSIONS: Soft palate resection is a good surgical procedure for therapy of obstructive apnea during sleep, with only slight secondary effects.
Serum lipoprotein(a) (Lp(a)) levels were measured in 89 men with peripheral vascular disease (PVD) and 129 (100 male and 29 woman) healthy controls. Apolipoprotein(a) genetic polymorphism was determined by immunoblotting in all subjects. Patients with PVD had significantly higher serum Lp(a) levels than controls. Apolipoprotein(a) phenotype frequencies in patients with PVD did not differ from those of the control group. Both patients and controls with phenotype S2 had higher serum Lp(a) levels than those with phenotype S4. It should be emphasized that serum Lp(a) levels were significantly higher in PVD patients than controls for those with phenotype S2, S3/S4 and S4. Raised serum Lp(a) levels together with other lipoprotein abnormalities in patients with PVD imply a high cardiovascular risk. Genetic polymorphism clearly influences serum Lp(a) levels both in patients and controls. In patients with PVD, environmental and/or other genetic factors must play a role in raising Lp(a) levels.
Sjögren's syndrome (SS) is a systemic, autoimmune exocrinopathy in which destructive, inflammatory-cell infiltration can affect any gland. Although chronic atrophic gastritis is the most common form of gastrointestinal involvement in SS, pernicious anemia develops in rare cases. We therefore report a patient with these three associated diseases.
OBJECTIVE: To assess the validity of calculated low-density lipoprotein cholesterol by the Friedewald formula for management of lipoprotein abnormalities in patients with diabetes mellitus. RESEARCH DESIGN AND METHODS: Calculated LDL cholesterol by the Friedewald formula was compared with measured LDL cholesterol after separation by ultracentrifugation in 61 patients with type I diabetes, 50 patients with type II diabetes, and 116 healthy control subjects. RESULTS: Calculated LDL cholesterol coincided with measured LDL cholesterol, with < 10% error, in 54 (49%) patients with diabetes mellitus, and 85 (73%) control subjects. Calculated LDL cholesterol was overestimated, with an error of > or = 10% of measured LDL cholesterol in 39% of patients and 26% of control subjects, and underestimated in 13 and 1%, respectively. Despite a good correlation between calculated and measured LDL cholesterol, the intraclass correlation coefficients demonstrated a poor concordance between calculated and measured LDL cholesterol, both in patients and control subjects. When comparing the mean differences of calculated and measured LDL cholesterol for diabetic subjects versus control subjects, significantly greater differences in type II (but not type I) diabetic subjects were seen. CONCLUSIONS: Calculation of LDL cholesterol by the Friedewald formula may be inaccurate for assessment of cardiovascular risk in patients with type II diabetes and may not be appropriate for management of lipoprotein abnormalities in those diabetic patients.