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Biomedical subjects

M S Elisaf

Publications and source records attributed to M S Elisaf.

At least 91 records · Page 5Linked to original sources
PubMed1997

Effects of conventional vs. low-molecular-weight heparin on lipid profile in hemodialysis patients.

Cardiovascular disease is one of the major causes of death in hemodialysis patients and seems to be related, at least in part, to lipid abnormalities. It has been suggested that in these patients low-molecular-weight heparin (LMWH) is superior to conventional heparin because it causes less side effects and has beneficial effects on lipid parameters. Our study was carried out to examine the long-term effects of the replacement of conventional heparin by LMWH on the lipoprotein profile in a large group of hemodialysis patients. A total of 76 patients aged 15-61 years receiving hemodialysis for 48 (range 10-169) months were studied. In all patients administration of LMWH was introduced in doses of 2,500-5,000 anti-factor Xa units for 12 months. Then, we randomly switched half of the patients back to conventional heparin for another 12 months, while the remaining patients continued to receive LMWH for 12 months. In the whole group of patients the use of LMWH instead of conventional heparin was followed by a significant decrease in serum total cholesterol, triglyceride and apoprotein B levels. The continued use of LMWH for another 12 months in half of the patients was followed by a further significant improvement in the lipid profile. In contrast, no significant changes in serum lipid parameters were observed in patients switched back to conventional heparin. In conclusion, the use of LMWH instead of conventional heparin for anticoagulation during hemodialysis is followed by an improvement in lipid profile, which is evident only after long-term treatment.

Adolescent↗
PubMed1997

Lipoprotein (a) concentrations in patients with various dyslipidaemias.

Although the genetic background is the most important determinant of lipoprotein (a) (Lp(a)) concentration other factors, such as coexistent dyslipidaemia, could modify its levels. We undertook the present study to examine the serum Lp(a) concentration in various dyslipidaemias and to reveal any correlation of serum Lp(a) concentration with the other lipid parameters in a large group of dyslipidaemic Greek patients. A total of 242 patients followed as outpatients in our lipid clinic were studied. The patients were stratified into four main groups. Patients with cholesterol levels greater than 5.17 mmol/L but normal triglycerides were regarded as hypercholesterolaemic (n=85), patients with triglycerides greater than 2.25 mmol/L but normal cholesterol levels as hypertriglyceridaemic (n=51), patients with both increased cholesterol and triglyceride levels as having mixed hyperlipidaemia (n=62), and finally patients with decreased (<0.90 mmol/L) high-density lipoprotein (HDL) cholesterol but normal cholesterol and triglyceride levels as having primary hypoalphalipoproteinaemia (n=44). Hypercholesterolaemic patients exhibited the highest serum Lp(a) levels, while hypertriglyceridaemic patients exhibited the lowest. Patients with mixed hyperlipidaemia had intermediate serum Lp(a) concentration, which was significantly higher than that of hypertriglyceridaemic patients but significantly lower than that of hypercholesterolaemic patients. Interestingly, patients with low serum HDL-cholesterol levels presented with low serum Lp(a) concentration similar to that of hypertriglyceridaemic patients. In hypercholesterolaemic patients no correlation was found between serum total and low-density lipoprotein (LDL) cholesterol nor apolipoprotein B (apoB) levels and Lp(a) concentration. On the contrary, in hypertriglyceridaemic patients an inverse correlation was observed between serum triglycerides and Lp(a) concentration. After dividing the hypertriglyceridaemic patients into one group with elevated (>1.3 g/L) serum apoB levels (n=32) and another group with normal apoB levels (n=19), we found that the median serum Lp(a) concentration was three times higher in hyperapoB patients compared to patients with normal apoB levels. We conclude that serum Lp(a) levels are different in various types of primary hyperlipidaemia and are modulated according to the type of lipid elevation.

Adult↗
PubMed1996

Acid-base and electrolyte disturbances in patients with diabetic ketoacidosis.

We undertook the present study to examine the acid-base and electrolyte disturbances in relation to hydration status in patients with diabetic ketoacidosis (DKA). A total of 40 insulin-dependent diabetes mellitus patients (22 male, 18 female), aged 18-61 years with DKA admitted to our hospital during the last 2 years, were studied. The duration of diabetes averaged 9 +/- 2 years. In all cases a detailed investigation of the acid-base status and electrolyte parameters was performed. Twenty-one patients had a pure metabolic acidosis with an increased serum anion gap, seven had DKA combined with hyperchloremic metabolic acidosis, nine had DKA coexisting with metabolic alkalosis, while three had DKA with a concurrent respiratory alkalosis. Hydration status as evidenced by the ratio of urea/creatinine seems to play an important role in the development of mixed acid-base disorders (detected by changes in the ratios delta anion gap/delta bicarbonate (delta AG/delta HCO3) and sodium/chloride (Na/Cl)). In fact, hyperchloremic acidosis developed in the patients with the better hydration status. However, contradictorily, the severely dehydrated patients who experienced recurrent episodes of vomiting developed DKA with a concurrent metabolic alkalosis. Finally, patients with pneumonia or gram-negative septicemia exhibited DKA combined with a primary respiratory alkalosis. We conclude that patients with DKA commonly develop mixed acid-base disorders, which are partly dependent on patients' hydration status.

Adolescent↗
PubMed1996

Elevated interleukin-1 beta in the circulation of patients with essential hypertension before any drug therapy: a pilot study.

Immune system disturbances have been implicated in the pathogenesis of essential hypertension. The aim of this study was to determine the levels of the interleukin-1 beta and soluble interleukin-2 receptors in serum samples from 114 hypertensive patients before any drug therapy because there are no well-established data regarding these immunologic mediators in essential hypertension. We found increased levels of interleukin-1 beta in 59.6% of patients, while soluble interleukin-2 receptors were not detected. The interleukin-1 beta levels were significantly higher in patients than in healthy controls (P = 0.0001). We conclude that patients with essential hypertension have high levels of interleukin-1 beta but not indicators of cellular immune activation in their sera. Further studies are in progress in order to confirm, explain and assess the clinical utility of the above findings.

Adult↗
PubMed1996

Chronic hyponatremia due to reset osmostat in a patient with colon cancer.

A 62-year-old man with colon cancer who presented with hyponatremia is described. Volume depletion, renal failure, and cardiac, adrenal, hepatic, and thyroid diseases were excluded as causes of hyponatremia. The urine sodium concentration was repeatedly increased, suggesting the presence of the syndrome of inappropriate antidiuretic hormone secretion. An intact urinary diluting ability and the ability to maintain sodium balance without correcting hyponatremia when the sodium intake was high were consistent with the diagnosis of the reset osmostat variant of the syndrome of inappropriate antidiuresis.

Adenocarcinoma↗
PubMed1996

Long-term effects of low molecular weight heparin on lipid parameters in hemodialysis patients.

OBJECTIVE: The long-term effects of the replacement of conventional heparin by low-molecular weight heparin (LMWH) on lipid parameters were examined in a large group of hemodialysis patients. EXPERIMENTAL DESIGN: One-year prospective investigation. SETTING: Renal units. PATIENTS: A total of 93 patients aged 12-63 years old receiving hemodialysis for 51 (1-172) months were studied. None of the patients had primary hyperlipidemia, diabetes mellitus, or other secondary causes of dyslipidemia. INTERVENTIONS: In all patients administration of LMWH was introduced in doses 2500-5000 units. MEASURES: Baseline values of lipoprotein profile prior to the intervention were compared with results obtained after 3, 6 and 12 months of LMWH. RESULTS: During of LMWH treatment a small but statistically significant decrease of total and HDL cholesterol (from 200 +/- 45 mg/dl to 185 +/- 42 mg/dl, p < 0.01, and from 45 +/- 11 mg/dl to 42 +/- 10 mg/dl, p < 0.05, respectively), as well as Apo B (from 128 +/- 36 mg/dl to 121 +/- 35 mg/dl, p < 0.001) was noticed. Moreover, triglycerides decreased significantly (from 175 +/- 73 mg/dl to 146 +/- 62 mg/dl, p < 0.001). The beneficial effects of LMWH were more pronounced in patients with dyslipidemia (total cholesterol > 200 mg/dl, or triglycerides > 200 mg/dl) before the replacement of conventional heparin. CONCLUSION: The long-term use of LMWH instead of conventional heparin for anticoagulation during dialysis has beneficial effects on the lipoprotein profile, especially in patients with dyslipidemia.

Adolescent↗
PubMed1995

alpha-Amylase and isoamylase levels in renal transplant recipients compared to uremic patients.

Hyperamylasemia is a common finding in chronic renal failure (CRF) patients. The present study was designed to evaluate the frequency, the type, and the hyperamylasemia levels in renal transplant recipients (RTR) compared to patients with renal failure with or without replacement of renal function. One hundred and forty-one subjects [42 with varying degree of renal insufficiency (group A), 74 on hemodialysis (group B), and 25 RTR (group C)] and 47 normal individuals were studied. Total serum alpha-amylase (Ta) as well as pancreatic (Pa) and salivary (Sa) types of serum isoamylases were elevated in all groups when compared to the levels found in normal subjects. A remarkable proportion of patients belonging to groups A and B had Ta as well as Pa levels over three times the upper normal limits. On the contrary, no RTR had such increased levels of both Ta and isoamylases. A statistically significant correlation was found between Ta, Pa, and Sa and serum creatinine in RTR. However, no statistically significant correlation was found between urine amylases and serum creatinine or between urine and serum levels in all amylases in this group. In conclusion, serum amylase levels are increased in RTR. However, no subject in this group had amylase and isoamylase values more than three times the upper normal limits, which was a common finding in the other groups of patients.

Analysis of Variance↗
PubMed1993

Lipid abnormalities in chronic uremic patients. Response to treatment with gemfibrozil.

Seventy-four patients with end stage renal failure were studied. Forty-six of them were on hemodialysis (HD) while 28 were on continuous ambulatory peritoneal dialysis (CAPD). In addition 56 nondialysis chronic renal failure (NDCRF) patients with various degree of renal failure were also studied. In all groups serum triglyceride concentrations were significantly higher and HDL cholesterol concentrations were significantly lower compared to age- and sex-matched controls. Total and LDL cholesterol were significantly higher in the NDCRF and CAPD patients compared to controls. In 55 patients (20 on HD, 13 on CAPD and 22 NDCRF) with severe hypertriglyceridemia or diminished HDL cholesterol gemfibrozil 300 mg b.i.d. per os was given for 6 months. Drug treatment reduced significantly serum triglycerides in all groups of patients and increased the levels of HDL cholesterol in CAPD patients. Moreover, a statistically significant decrease of the levels of total and LDL cholesterol was noticed in HD and NDCRF patients. During treatment no significant side effects were observed and liver and muscle enzymes remained within normal values.

Adult↗
PubMedDate not supplied

Mechanisms of hyponatraemia in alcohol patients.

Hyponatraemia is commonly reported in chronic alcoholic patients. However, the underlying pathogenetic mechanisms are not well delineated. In the current study, we analysed the possible pathophysiological mechanisms of hyponatraemia in a group of alcoholic patients (n = 127) admitted to our hospital for causes related to alcohol misuse. Hyponatraemia (serum sodium <134 mmol/l) was found in 22 patients (17.3%). The most common cause of hyponatraemia in our cohort was hypovolaemia (12 patients); pseudohyponatraemia was diagnosed in six patients with alcohol-induced severe hypertriglyceridaemia. It is of interest that two patients fulfilled the criteria of the so-called 'beer potomania' syndrome, while in two others, hyponatraemia was due to reset osmostat or to cerebral salt wasting syndrome, not previously described in alcoholic patients. It is concluded that hyponatraemia is a frequently observed electrolyte disorder in hospitalized alcoholic patients and is related to various pathophysiological mechanisms.

Adult↗
PubMedDate not supplied

Lipid parameters including lipoprotein (a) in patients undergoing CAPD and hemodialysis.

OBJECTIVE: Dyslipidemia possibly contributes to the vascular complications commonly afflicting uremic patients. Lipoprotein (a) [Lp(a)] has been identified as an independent risk factor for atherosclerotic vascular disease. The aim of our study was to compare lipidparameters, including Lp(a), between hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A cross-sectional study. SETTING: University Medical Center. PARTICIPANTS: Forty CAPD and 40 HD patients carefully matched for age, sex, body mass index (BMI), smoking habits, and duration of dialysis were studied. A group of 40 healthy individuals matched for age, sex, BMI, and smoking habits was used as control. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Serum lipid parameters and atherogenic risk ratios were the main outcome measures. RESULTS: Both groups of dialysis patients had increased serum triglycerides and decreased levels of ApoA1 and HDL cholesterol compared to controls. Moreover, the risk ratios total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol were significantly higher, and the ratio ApoA1/ApoB was significantly lower in both groups of patients in comparison to the normal subjects. Both groups of dialysis patients exhibited decreased ratios of LDL cholesterol/ApoB and HDL cholesterol/ApoA1, suggesting the presence of compositional lipoprotein changes. CAPD patients had a more atherogenic lipid profile compared to HD patients, since they exhibited higher levels of total and LDL cholesterol, of ApoB as well as of the ratios total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol, and lower levels of the ratio ApoA1/ApoB compared to HD patients. Both groups of dialysis patients had increased serum Lp(a) levels. Even though CAPD patients had higher serum Lp(a) levels than HD patients, the differences between these two groups were only marginally statistically significant (p = 0.056 by Mann-Whitney U-test). Uremic dyslipidemia was positively correlated with serum albumin levels in both groups of patients. CONCLUSION: CAPD patients exhibit a more atherogenic lipid profile than that of HD patients. The marked disturbances in Lp(a) levels may further increase the vascular risk in both groups of patients.

Adolescent↗