Septic arthritis in a general hospital 1966-1977

Eighty-seven patients with septic arthritis diagnosed from 1966 through 1977 are described. Thirty-three had gonococcal arthritis, of whom 31 were women. Twenty were between the ages of 20-29 years. The commonest joint involved was the wrist. Culture of synovial fluid was positive for N. gonorrhea in 11. Fifty-four patients had non-gonococcal arthritis, of whom 40 were men. The mean age was 38 years. S. aureus was the commonest organism cultured. The knee was the most frequently involved. Treatment with iv antibiotics and aspiration was usually successful.

Serum lipids and high density lipoprotein cholesterol in peripheral vascular disease

Serum lipids and high density lipoprotein (HDL) cholesterol concentrations were measured in 32 patients with peripheral vascular diseases (PVD) and 38 control subjects. Hypertriglyceridaemia (> 1.8 mmol/l) was significantly more common in PVD patients of both sexes than among controls but mean serum triglyceride levels were significantly higher only among males. Hypercholesterolaemia (> 7 mmol/l) was not more common in PVD patients nor did mean serum total cholesterol or HDL cholesterol levels differ significantly from control subjects. The HDL ratio, however, was significantly reduced in both males and females with PVD. These results suggest that expressing the amount of cholesterol carried in HDL in relative terms is a better index of vascular risk than is its absolute concentration. The HDL cholesterol level and the HDL ratio were both significantly lower in controls who smoked than in non-smokers; this may explain the reduced HDL ratio in PVD patients, most of whom were smokers.

Assessment of long-term plasma exchange for familial hypercholesterolaemia

The effectiveness of repeated plasma exchange with 2 to 4 litres of plasma protein fraction as long-term treatment for familial hypercholesterolaemia has been evaluated in six severely affected patients receiving conventional cholesterol lowering treatment. Cell-separator mediated exchange at monthly intervals for one to two years reduced mean serum cholesterol levels from 18.5 mmol/l (715 mg/dl) to 12.4 mmol/l (480 mg/dl) in two female homozygotes but failed to influence xanthomata or prevent a two- to threefold increase in their left ventricular aortic systolic pressure gradients. More effective reduction of mean serum cholesterol levels from 15.7 mmol/l (608 mg/dl) to 8.6 mmol/l (333 mg/dl) in two male homozygotes by plasma exchange at fortnightly intervals for two to three years was accompanied by resolution of xanthomata and by stabilisation of aortocoronary lesions. In two male heterozygotes with angina, coronary angiographic appearances were unaltered or improved after one to two years of thrice-monthly plasma exchange, which reduced mean serum cholesterol levels from 6.4 mmol/l (248 mg/dl) to 4.7 mmol/l (182 mg/dl). We conclude that plasma exchange every one to two weeks, combined with oral nicotinic acid and/or cholestyramine, retards the rate of progression of atheroma in homozygotes and possibly induces regression in heterozygotes.

Reiter's disease after Salmonella typhimurium enteritis

We describe a case of Reiter's disease in an HLA-B27 positive black woman after infection with Salmonella typhimurium. Although reactive arthropathy following Salmonella infections is not unusual, Reiter's disease is rare. This may be the second such case in the English literature, and the first reported in North America.

Effect of lipoprotein concentration and lecithin: cholesterol acyltransferase activity on cholesterol esterification in human plasma after plasma exchange

The rate of cholesterol esterification in plasma, plasma lecithin cholesterol acyltransferase (LCAT) activity and plasma lipoprotein levels have been measured in five subjects who underwent therapeutic plasma exchange to reduce their plasma cholesterol concentration. In the week following the exchange the cholesterol esterification rate and the plasma triglyceride concentration returned rapidly in parallel to pre-exchange levels, while high density lipoprotein (HDL) cholesterol and LCAT activity returned to normal more slowly but also in parallel. The data suggest that the rate-limiting factor for cholesterol esterification in plasma is unlikely to be solely the enzyme levels, but is probably a combination of factors, including the enzyme level and either substrate availabiltiy or product removal. Plasma very low density lipoprotein (VLDL) may either provide substrates for the reaction or provide a means of removing one of the products from the site of reaction.

Congenital dyserythropoietic anaemia (CDA) with severe gout, rare Kell phenotype and erythrocyte, granulocyte and platelet membrane reduplication: a new variant of CDA type II

A 43-year-old man with lifelong anaemia showed features which indicate him to have a previously undescribed variant of congenital dyserythropoietic anaemia (CDA), type II. The main clinical features--of which the first two are unique or very unusual in CDA--have been severe tophaceous gout, massive splenomegaly, gall stones mecessitating cholecystectomy and haemosiderosis affecting the liver and probably the heart. At age 41 he sustained a spontaneous retinal detachment. In the peripheral blood there were large numbers of nucleated red blood cells and marked macrocytosis; otherwise the picture was typical of CDA type II. The bone marrow contained many bi- and multi-nucleated erythrocyte precursors. There were increased levels of a number of red cell enzymes and a slightly raised level of HbF. Uncharacteristically, the red cells failed to lyse with acidified normal serum. The cells were strongly agglutinated by anti-i and were of the rare Kpb-negative phenotype. Plasma lipid analysis showed very low levels of cholesterol and vitamin E. Lipid peroxidation was markedly increased. Ultrastructural studies showed reduplication of the erythrocyte, granulocyte, and platelet cell membranes.

Uptake and cellular degradation of low-density lipoprotein

In vitro data suggest that low-density lipoprotein (LDL) is bound to specific receptors located in pits on the surface of fibroblasts by a high-affinity process and subsequently undergoes catabolism in lysosomes. This binding seems to be mediated by ionic interaction between LDL and its receptor, the latter being totally or partially absent from the fibroblasts of patients with familial hypercholesterolaemia (FH). In vivo data suggest that LDL is also catabolised by a concentration-dependent, low-affinity pathway which is probably mainly located in the liver. LDL catabolism is reduced in FH and after saturated fat feeding, whereas polyunsaturated fat has the reverse effect. Hypocatabolism of LDL alters LDL composition, accelerates atherosclerosis and may lead to premature death from coronary heart disease.

Effect of hyperlipidaemia on pulmonary diffusing capacity for carbon monoxide

There is conflicting evidence on the effect of hyperlipidaemia on pulmonary diffusing capacity for carbon monoxide (DLCO or TLCO) in man. We have measured the carbon monoxide transfer factor per unit alveolar volume (TLCO/VA or KCO) by the single breath method in 25 patients with hyperlipidaemia, and in three normal subjects before and after infusions of an intravenous fat emulsion, Intralipid. Non-smokers with hyperlipidaemia had normal levels of TLCO/VA, whereas some of the smokers showed a slight reduction. In neither group was there any correlation of TLCO/VA with serum triglyceride or cholesterol concentrations. A reduction in triglyceride concentrations of up to five-fold produced by plasma exchange (three studies in two patients) or by dietary manipulation (one patient) had no significant effect on the levels of TLCO/VA. Intralipid infusion in three normal subjects caused a four- to five-fold increase in serum triglyceride concentration but had no effect on TLCO/VA. We conclude that moderate degrees of hyperlipidaemia have no effect on pulmonary diffusion.

Metabolism of apolipoprotein B-containing lipoproteins in familial hypercholesterolaemia: effects of plasma exchange

The turnover of apolipoprotein B (apo B) in very low density lipoprotein (VLDL), intermediate density lipoprotein (IDL) and low density lipoprotein (LDL) was investigated in 2 homozygous and 3 heterozygous patients with familial hypercholesterolaemia. The effects of a marked reduction in plasma LDL concentration, brought about by plasma exchange, upon apo B turnover were studied in 4 patients. Specific activity-time curves for the the plasma apo B after intravenous radioactive VLDL before plasma exchange indicated that in the heterozygotes all IDL-apo B was derived from VLDL and all LDL-apo B was derived from IDL, but the curves from the homozygotes showed that a significant fraction of the LDL in the plasma was not derived from IDL. Plasma exchange did not increase the rates of synthesis of LDL-apo B or VLDL-apo B and had no significant effect on the precursor--product relationship between IDL-apo B and LDL-apo B in heterozygous or homozygous patients. These findings provide no support for the hypothesis that apo B synthesis is controlled by the plasma LDL.

Reduction of blood viscosity following plasma exchange

The effect of plasma exchange with plasma protein fraction on blood viscosity was determined in seven hyperlipoproteinaemic patients with coronary or peripheral vascular disease. This resulted in decreases in whole blood viscosity of 83% and 30% respectively at the lowest and highest shear rates studied, and decreases of 21% and 59% in plasma viscosity and fibrinogen. Serum cholesterol and triglyceride were reduced by 66% and 48% respectively. Sequential studies in two patients showed that blood viscosity returned to near-basal values by the 6th day. These findings suggest that plasma exchange may result in short-term enhancement of blood flow in vessels where low shear rates predominate.

Reversible abnormalities of low density lipoprotein composition in familial hypercholesterolaemia

Low density lipoprotein (LDL) composition was analysed in twenty-one patients with familial hypercholesterolaemia, including six homozygotes. By comparison with nineteen controls the patients' LDL had an increased ratio of cholesterol:phospholipid and a decreased ratio of lecithin:sphingomyelin; these changes were more marked in homozygotes than in heterozygotes. Treatment of sevel patients with plasma exchange temporarily resulted in near-normalization of the composition of their LDL. These results suggest that abnormalities of LDL composition in familial hypercholesterolaemia are secondary to hypocatabolism of LDL, which prolongs the half-life of LDL and thus increases the mean age of the population of particles circulating in plasma.

Septic bursitis

In 12 cases of septic bursitis seen during 11 years, 11 patients were men and one patient was a woman, with a mean age of 51.3 years. The olecranon bursa was involved in nine cases. Staphylococcus aureus was grown from nine of ten culture-positive fluids. Bursal fluid WBC counts ranged from 1,550/cu mm to 165,000/cu mm, associated with low glucose levels in two cases, but not in three. Treatment with antibiotics and needle aspiration or surgical drainage was successful.

Familial occurrence of hyperuricemia, gout, and medullary cystic disease

We observed hyperuricemia, acute gouty arthritis, and renal medullary cystic disease in three members of a family over two generations. Two of these individuals were women who developed gout by age 20 years. Two teenage sons of one of these patients had severe hyperuricemia, which appeared due to underexcretion of uric acid. To our knowledge the occurrence of hyperuricemia, gout, and renal medullary cystic disease has not been reported previously.

Testicular effects of cyclohexylamine hydrochloride in the rat

Testicular effects of cyclohexylamine hydrochloride (CHA) were investigated in Wistar and Sprague-Dawley rats. Groups of 25 rats were fed diets containing 6000, 2000 and 600 ppm CHA for 90 days and in addition ad lib., pair-fed and paired-weight control groups were used to assess the role of reduced food intake in the development of testicular lesions. Rats fed diets containing 6000 and 2000 ppm CHA showed significant decreases in food consumption, body weight and body weight gain. However, significant increases in the incidence of testicular lesions were found only in those animals fed 6000 ppm CHA. Absence of a similar incidence of lesions in either the paired-weight of pair-fed control groups indicated that inanition was not primarily responsible for the development of the lesions. The toxicological significane of these findings is discussed.

HLA and recurrent episodic arthropathy associated with rubella vaccination

The frequencies of 21 HLA antigens in 33 patients who developed recurrent, episodic arthropathy after receiving the HPV-77 DK-12 rubella vaccine have been determined and compared with those of a control population. Trends toward increased frequencies of HLA antigens B12 (P = 0.02) and B14 (P = 0.04) and of the haplotype A2, B12 (P = 0.01) did not reach significance when corrections for the number of antigen determinations were included in the statistical analysis. These data show that the syndrome of recurrent arthropathy following rubella vaccination is genetically distinct from the connective tissue diseases associated with HLA-B27.

Non-stedy-state studies of low-density-liproprotein turnover in familial hypercholesterolaemia

1. The non-steady-state turnover of low-density lipoprotein (LDL), labelled in its apoprotein moiety (apo-B) with 131I, was determined in four patients with familial hypercholesterolaemia, three of them homozygotes. 2. The fractional and absolute catabolic rates (FCR and ACR) of LDL-apo-B were determined by relating the excretion of radioactivity, measured in urine in vitro and by whole-body counter in vivo, to plasma radioactivity and to LDL specific radioactivity respectively. 3. The FCR remained relatively constant, even after marked reduction of LDL pool size by means of plasma exchange. This confirms the existence of an intrinsic defect in LDL catabolism in familial hypercholesterolaemia. 4. LDL-apo-B synthesis, determined by summing the ACR and the daily increment in plasma LDL, was much higher in the three homozygotes than in the one heterozygote, in whom the synthetic rate was normal. 5. These results illustrate the usefulness of combining plasma exchange and whole-body radioactivy counting as a means of examining the relationship between the turnover and pool size of a 131I-labelled protein, such as LDL.

Accentuation of ethanol-induced fatty liver by phenobarbitone

1. Four groups of rats received a liquid formula diet, given alone (control), or supplemented with either ethanol or phenobarbitone, or both together. 2. The ethanol-treated group showed a fall in plasma triglyceride and a rise in liver triglyceride, as compared with the control rats. 3. The phenobarbitone-treated group showed a marked rise in plasma triglyceride but not in liver triglyceride. 4. The group receiving both ethanol and phenobarbitone also showed a rise in plasma triglyceride, but this was accompanied by a striking increase in liver triglyceride. 5. These results suggest that ethanol and phenobarbitone each stimulate triglyceride synthesis but that in addition ethanol has an inhibitory effect on hepatic triglyceride secretion.

The metabolism in vivo and in vitro of plasma low-density lipoprotein from a subject with inherited hypercholesterolaemia

1. The metabolism in vivo and in vitro of an abnormal low-density lipoprotein (LDL) obtained from a patient with an inherited form of hypercholesterolaemia was compared with that of LDL obtained from a normal subject. 2. The rates of turnover of the apoprotein of the two types of LDL in a normal subject, and their uptake and catabolism by normal lymphocytes in vitro, were similar. 3. It is concluded that the abnormal behaviour of the patient's LDL may not be due to an abnormality in the apoprotein component.

Solid phase radioimmunoassay of apolipoprotein B (apo B) in normal human plasma

A solid phase radioimmunoassay (RIA) has been developed for apolipoprotein B (apoB), a major constituent of very low density lipoprotein (VLDL) and low density lipoprotein (LDL) in man. Antisera were prepared against apoB in goats and rabbits, coupled to bromoacetyle cellulose, and the complex was incubated with [125I] LDL. The RIA was based on the displacement of [ 1252]-LDL by unknown samples, as compared with unlabeled LDL standards, using a logit transformation to calculate results. The RIA was found to be satisfactory in terms of precision, sensitivity, reproducibility and specificity. Control subjects had mean apoB levels of 94 mg/100 ml in whole fasting plasma, of which 3.6 mg/100 ml plasma were in the VLDL, while 86 mg/100 ml plasma were in the LDL. Both the triglyceride and apoB content of VLDL, and the cholesterol and apoB content of LDL were positively correlated. It is concluded that the solid phase radioimmunoassay described in the present report provides a rapid and relatively simple means of quantitating apoB in normal human plasma.

Effects of intravenous phospholipid on low density lipoprotein turnover in man

The mechanism of the rise in plasma low density lipoprotein (LDL) levels following intravenous administration of a triglyceride-phospholipid emulsion (Intralipid) has been investigated by measuring LDL turnover in eight healthy subjects. The plasma half-life, and the absolute and fractional catabolic rates of LDL protein (apo-LDL) were unaffected by intragastric Intralipid, whereas apo-LDL half-life was prolonged and its fractional catabolic rate was decreased by intravenous Intralipid. Similar changes were observed after intravenous administration of the egg phospholipid constituent of Intralipid. Accompanying increases in the oleate: linoleate ratio of both high and low density lipoprotein cholesterol esters were secondary to phospholipid exchange between infused and endogenous lecithin. These results suggest that the increased concentration of LDL in plasma following intravenous administration of egg phospholipid-containing emulsions was due, at least in part, to a decrease in the fractional catabolic rate of apo-LDL. The data further suggest a possible relationship between apo-LDL catabolism and the fatty acid composition of LDL.

Contrasting effects on plasma lipoproteins of intravenous versus oral administration of a triglyceride-phospholipid emulsion

The effect of fat on plasma lipoproteins was compared when administered by the oral and intravenous routes to healthy control subjects on a low fat diet for 5-6 weeks. During this time each subject underwent two 5 day periods of fat supplementation with a soya bean triglyceride-egg yolk phospholipid emulsion (Intralipid), once via intragastric tube, once intravenously. Changes in plasma lipoproteins were assessed by measurement of their lipid and protein content. Intragastric fat administration significantly decreased the level of very low density lipoprotein (VLDL), whereas intravenous fat administration caused a significant rise in low density lipoprotein (LDL). Morphological evidence of persistence of exogenous phospholipid in plasma following intravenous fat administration was confirmed by alterations in the fatty acid composition of lecithin in the d 1.006-1.063 fraction of plasma. In vitro studies showed that exchange readily occurred between Intralipid and LDL lecithin, causing the latter to assume a more saturated pattern. It is concluded that the occurrence of similar changes in vivo could explain the rise in low density lipoprotein following intravenous fat, possibly by influencing the catabolic rate of the apoprotein. Hydrolysis of ingested phospholipids during absorption presumably explains why none of these changes occurred after oral fat supplementation, and would seem to be an important regulatory function of the small intestine in relation to plasma lipoprotein metabolism.

Plasma exchange in the management of homozygous familial hypercholesterolaemia

Two young women with homozygous familial hypercholesterolaemia and coronary and aortic atheroma were treated by repeated plasma exchange, using a continuous-flow blood-cell separator, for 4 and 8 months. A pronounced reduction in plasma cholesterol and low-density lipoprotein (L.D.L.) concentrations was achieved by exchanging each patient's plasma with cholesterol-free plasma protein fraction (B.P.), at 3-weekly intervals on an outpatient basis. By pre-labelling the patients' cholesterol with 14-C and comparing the specific activity of the cholesterol in adipose tissue with that in plasma, evidence was obtained of an influx of tissue cholesterol into plasma after each exchange. There was no side-effects and both patients lost their angina. Plasma exchange offers a new and practical approach to the long-term management of this lethal disorder and may also provide information about the possible reversibility of human atheroma.

Rotator cuff tears in rheumatoid arthritis

Rotator cuff tear secondary to chronic synovitis eroding the rotator cuff tendon is a complication of rheumatoid arthritis that has received little attention. Patients with such tears have a long history of active rheumatoid disease preceding the sudden onset of increased unilateral shoulder pain and immobility. The physician may interpret this change as indicating a joint infection or rheumatoid flare, and initiate a drastic change in the patient's therapy. Shoulder arthrography reveals the correct diagnosis. Appropriate treatment consists of heat, rest, range of motion exercises, and repeated intra-articular injection of steroids.

Versatile unit for filling gelatin capsules with drugs or chemicals

A new, inexpensive device was developed for making individually prepared capsules that can be administered to experimental animals. The device was designed for accurate and rapid production of large numbers of various capsule sizes and drug dosages. During 12 months of usage, 21 capsules were prepared weekly for each of 44 dogs (924 total capsules) in approximately 2.5 work-hours/week. Each capsule contained a precise amount of drug to administer a specific dosage to each individual dog. No difficulties were encountered in the manufacture or utilization of this device, and it can be operated by untrained personnel.

Effects of delta-9-tetrahydrocannabinol administered subcutaneously to rabbits for 28 days

Subcutaneous (s.c.) administration of delta-9-tetrahydrocannabinol (delta-9-THC) to rabbits produced dose-related cumulative toxicity. Five groups of three New Zealand albino rabbits each received 28 daily treatments with isotonic saline, sesame oil of 15.9, 45.0 or 153.4 mg/kg/day of delta-9-THC dissolved in sesame oil. Dose-related dermal responses included erythema, edema, ulceration and nodule formation. Some of the granulomatous nodules contained an oily substance and exhibited liquefactive necrosis. The severities of erythema and ulceration were generally maximal during the first week of treatment, but edema and nodule formation were most severe after days 12 and 14, respectively. All rabbits survived treatment, but body weights, liver weights and liver glycogen levels were decreased in a dose-related manner. Maximal body weight effects occurred after day 19. Hemochemical changes occurred only in rabbits treated with 153.4 mg/kg/day and included decreased blood sugar and alkaline phosphatase, and increased serum potassium. Hematology parameters were normal throughout the treatment period. No drug-related pathological lesions occurred in internal organs. The cumulative body weight changes, significantly decreased hepatic glycogen levels and reduced blood sugar and alkaline phosphatase values may have indicated drug-induced metabolic changes.

Changes in the fatty acid composition of plasma lipoproteins during administration of Intralipid to a patient with essential fatty acid deficiency

1. The fatty acid composition of the cholesterol esters, triglycerides and lecithin components of the major plasma lipoprotein classes was determined before and after the intravenous infusion of a linoleate preparation into a patient with essential fatty acid deficiency.

2. Marked differences developed between the fatty acid composition of the cholesterol esters of very-low-density lipoprotein (VLDL) on the one hand and of low- and high-density lipoproteins (LDL and HDL) on the other hand.

3. The data suggest that the infused linoleate was selectively incorporated into LDL and HDL cholesterol esters by the action of plasma lecithin-cholesterol acyltransferase, after prior incorporation into lipoprotein lecithin. In contrast, there was no rise in the linoleate content of VLDL cholesterol esters, which probably originated in either the liver or the small intestine.

4. These findings support the concept that plasma cholesterol esters are heterogeneous.

Plasma post-heparin lipolytic activity in patients with malabsorption: effect of intravenous fat administration

1. Post-heparin lipolytic activity was determined in the plasma of thirteen patients with malabsorption and fourteen healthy controls, with a coconut-oil emulsion (Ediol), triolein and very-low-density lipoprotein (VLDL) as substrates.

2. Significantly lower post-heparin lipolytic activities were found in malabsorbers, whichever substrate was used. Lipolysis was inhibited by 0–5 mol/l sodium chloride when VLDL was the substrate but not when the two artificial substrates were used.

3. Plasma post-heparin lipolytic activities rose in malabsorbers after therapeutic doses of an intravenous fat emulsion (Intralipid), especially when assayed against VLDL.

4. The abnormal fatty acid composition of VLDL from malabsorbers did not affect its properties as a substrate for lipolysis by post-heparin plasma from normal subjects.

5. These findings support the concept that PHLA is heterogeneous in origin. They also suggest that if reduced clearance is a factor in the hypertriglyceridaemia sometimes seen in malabsorption, it is due to an enzyme deficit rather than a substrate defect.

Diagnosis and treatment of essential fatty acid deficiency in man

Essential fatty acid deficiency was found on four occasions in three adult patients with malabsorption after intestinal resection. Diagnosis was primarily based on the gas chromatographic finding of the abnormal fatty acid 5, 8, 11- (omega9) eicosatrienoic acid in plasma lecithin. None of the patients had received parenteral nutrition with a fat-free source of calories but all had been on a reduced intake of dietary fat at some stage. Treatment with intravenous Intralipid rapidly reversed the abnormal plasma fatty acid pattern and also cleared the rash in the patient wih he most severe deficiency.

Effect of phenobarbitone treatment on vitamin D metabolism in mammals

1. The metabolism of radioactive cholecalciferol was studied in control and phenobarbitone-treated rats and pigs.

2. Treatment with phenobarbitone enhanced the appearance in plasma of 25-hydroxycholecalciferol (peak IV on silicic acid chromatography), and of more-polar metabolites (peak V), but not of the most-polar metabolites (peak VI). Peak IV had the chromatographic properties of authentic 25-hydroxycholecalciferol (25-HCC) and had biological activity.

3. There was no effect on the appearance of peaks V and VI in plasma after an injection of radioactive 25-HCC.

4. Treatment with phenobarbitone enhanced the excretion of metabolites of radioactive vitamin D3 in bile. These metabolites were largely water-soluble conjugates of peaks IV, V and VI, which included glucuronides. Peak IV in bile was not identical with 25-HCC.

5. Prolonged treatment with phenobarbitone depleted the tissue radioactivity of rats given radioactive vitamin D3.

Plasma lipid and lipoprotein abnormalities in patients with malabsorption

1. Plasma lipids and lipoproteins have been studied in control subjects and patients with various types of steatorrhoea.

2. Low plasma cholesterol levels were found in malabsorbers and were associated with decreased amounts of low-density lipoprotein (LDL) in males and high-density lipoprotein (HDL) in females.

3. Serum triglyceride levels were normal in males, but exceeded control values in some of the females, due to an increase in very-low-density lipoprotein.

4. LDL composition was abnormal in both male and female malabsorbers, with a decreased proportion of cholesterol ester and an increased proportion of triglyceride. There was also an increased proportion of triglyceride in HDL.

5. These findings show that malabsorption markedly influences not only the concentration but also the composition of plasma lipoproteins.

Fatty acid composition of plasma lipoproteins in control subjects and in patients with malabsorption

The fatty acid composition of cholesterol (cholesteryl) ester, triglyceride, and lecithin has been investigated in whole plasma and individual lipoproteins of healthy control subjects, of patients with malabsorption, and also of patients without malabsorption. The results show a decreased proportion of the essential fatty acid linoleic acid in all three lipid classes in both groups of patients as compared with the healthy controls. This abnormality was more marked in the malabsorbers, especially those with steatorrhoea secondary to intestinal resection. Unequivocal biochemical evidence of essential fatty acid deficiency, as indicated by the appearance of 5, 8, 11 eicosatrienoic acid in plasma lecithin, was observed in two patients, both of whom had undergone major intestinal resections. The results suggest that intestinal resection predisposes to the development of essential fatty acid deficiency.