[Lipoprotein oxidation profile in end stage renal disease patients. Role of vitamin C supplementation]

BACKGROUND

The aim of the study was to analyze the lipid and lipoprotein oxidation profile in patients with end stage renal disease who started haemodialysis and also to evaluate the possible effect of haemodialysis and vitamin C supplementation on lipoprotein oxidation one year after the initiation of the therapy.

METHODS

Forty-one end stage renal disease patients who started haemodialysis between January 1999 and January 2000 were enrolled in the study. The patients were randomised to receive 1,000 mg/day of vitamin C or placebo and then hemodialysis was initiated. We measured the lipid profile and the susceptibility of LDL and HDL to oxidation using cooper ions, at the moment of inclusion and one-year after the treatment.

RESULTS

No significant differences were observed among the vitamin-C treated patients and those who received placebo. Our results show that haemodialysis by itself did not induce deletereous effects on the lipid profile, which was slightly improved. A small decrease in total cholesterol--183 to 164 mg/dl (group A), 170 to 144 mg/dl (group B); in LDL cholesterol (100 mg/dl to 79 mg/dl (group A), 88 mg/dl to 73 mg/dl (Group B); and in phospholipids [198 to 188 mg/dl, group A (Group A), 195 mg/dl to 178 mg/dl (Group B)], was observed in all the patients one year after starting haemodialysis. When considering oxidation-derivative products, the lag phase of LDL-cholesterol and HDL-cholesterol was enlarged but without statistical significance. A tendency to increase the vitamin E generation in HDL and LDL lipoproteins was observed in vitamin-C treated patients, but the difference still remained not significant.

CONCLUSIONS

Haemodialysis by itself could improve lipid profile in patients with a previous pro-oxidative state such as uraemia. Although our results have failed to demonstrate significant differences between vitamin C-treated and not treated patients, the tendency to decrease oxidation products by supplementation of vitamin C could mean a beneficial effect on oxidation parameters. In order to improve oxidative stress, the use of lipophylic more than hydrophilic vitamins could be evaluated in randomized studies with a more important number of patients.

[Compensatory sweating after upper thoracic sympathectomy. Prospective study of 123 cases]

OBJECTIVE

The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). De-pending on the series, the incidence of CS ranges from 24% to 85%. The aim of this study was to determine the relation between CS and the following factors: distribution of hyperhidrosis, procedure performed (unilateral, synchronic bilateral, or sequential bilateral), and number of sympathetic ganglia eliminated. In addition, the degree of patient satisfaction was recorded as objectively as possible.

PATIENTS AND METHODS

Prospective study of 123 patients who underwent upper thoracic sympathectomy for palmar and/or axillary hyperhidrosis between 1 January, 1996 and 1 June, 2002 at our unit. All patients completed a questionnaire on symptoms 8 weeks before and after surgery to deter-mine postoperative changes in distribution of the hyperhidrosis and the overall degree of satisfaction on a scale of 0 to 4.

RESULTS

The sensation of CS was reported by 86.1% of the patients. When asked to relate this sensation to changes in sweating intensity in specific parts of the body, 46.54% reported CS and 48.37% no change. The trunk was the only region where statistically significant increases in CS occurred; in the feet, a decrease in sweating was noted. No differences in CS were observed with respect to the type of surgery or the number of sympathetic ganglia eliminated. The overall results were considered very satisfactory or quite satisfactory by 84.55% of the patients, while 4.88% were very dissatisfied.

CONCLUSIONS

Although CS is a side effect of upper thoracic sympathectomy, not all patients are affected by it. Significant CS occurs mainly in the back, chest, and abdomen. Neither the type of intervention nor the number of ganglia eliminated has an effect on CS. This side effect notwithstanding, overall satisfaction with the treatment is very satisfactory given that the palmar hyperhidrosis is eliminated.

Perceptions of general environmental problems, willingness to expend federal funds on these problems, and concerns regarding the Los Alamos National Laboratory: Hispanics are more concerned than Whites

Perceptions about general environmental problems, governmental spending for these problems, and major concerns about the US Department of Energy's Los Alamos National Laboratory (LANL) were examined by interviewing 356 people attending a gun show in Albuquerque, New Mexico. The hypothesis that there are differences in these three areas as a function of ethnicity was examined. We predicted that if differences existed, they would exist for all three evaluations (general environmental problems, government spending, and environmental concerns about LANL). However, this was not the case; there were fewer ethnic differences concerning LANL. Hispanics rated most general environmental problems higher than Whites and rated their willingness to expend federal funds higher than Whites, although all groups gave a lower score on willingness than on concern. Further, the congruence between these two types of ratings was higher for Hispanics than for others. In general, the concerns expressed by subjects about LANL showed few ethnic differences, and everyone was most concerned about contamination. These data indicate that Hispanics attending a gun show are equally or more concerned than others about environmental problems generally but are not more concerned about LANL. The data can be useful for developing future research and stewardship plans and for understanding general environmental problems and their relationship to concerns about LANL. More generally, they indicate that the attitudes and perceptions of Hispanics deserve increased study in a general population.

Perceptual indicators of environmental health, future land use, and stewardship

There are important linkages between the health of humans and the environment, restoration of degraded lands, and long-term stewardship of public lands, yet most environmental indicators deal only with assessing the physical and biological aspects of ecosystems. In this article, we examine the ratings of perceptions of several environmental problems for their utility as indicators of environmental quality, and examine perceptions of future land use by people interviewed in Santa Fe, New Mexico, near the Department of Energy's (DOE) Los Alamos National Laboratory (LANL). Overall, people with lower incomes rated environmental problems as more severe than others, were more willing to spend federal funds to solve them, and were consistent in their ratings of severity of environmental problems and their willingness to spend federal funds. Cleaning up LANL and other Department of Energy sites, received the highest rating for expenditure of federal funds. The highest rated future uses for DOE sites were for recreation and for National Environmental Research Parks. People with less education generally gave higher ratings to most future land uses for DOE than did those with more education. However, those with higher education gave higher ratings to nuclear reprocessing, and nuclear material storage. Where there were differences, the people interviewed at Santa Fe rated all environmental problems (except pesticides) as more severe than did those previously interviewed in Albuquerque (located farther from the LANL site), and they were more willing to spend federal funds on these problems. Ratings for all future land uses did not differ between the Santa Fe and Albuquerque respondents. These perception-based indicators show general agreement among people living close and farther away from LANL with respect to cleaning up LANL and the future land uses for the site. These indicators should be considered by regulators, site personnel, and policy makers in future management and land use decisions.

[Silent ischemic heart disease in patient with Wegener's necrotizing glomerulonephritis]

Wegener's granulomatosis is a necrotizing vasculitis disorder that usually presents with clinical involvement of the upper and lower respiratory tract in association with renal disease. Although Wegener's granulomatosis can affect other systems, such as the eye, skin, joints, muscle, nerves, gastrointestinal tract and heart, cardiac involvement is traditionally believed to be rare, even though coronary vasculitis can be demonstrated at postmortem examination. We report a patient who has both respiratory and renal involvement who died unexpectedly following a silent myocardial infarct after a period of clinical improve induced by treatment with cyclophosphamide and prednisone.

An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas

AIM

To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population.

METHOD AND RESULTS

A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women.

CONCLUSIONS

The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.

[Histopathological changes in sympathetic ganglia of patients treated surgically for palmar-axillary hyperhidrosis. A study of 55 biopsies]

INTRODUCTION

Primary palmar hyperhidrosis (PPH) mainly affects the sympathetic ganglia. This study aims to analyze the histopathological changes in the sympathetic ganglia of patients with PPH.

MATERIAL AND METHOD

We studied 55 tissue samples from 35 patients with PPH who underwent T2-T3 gangliectomy for definitive treatment of their disease, analyzing the presence of inflammation, chromatolysis and lipofuscin accumulation. Findings were analyzed in relation to age, compensatory sweating and type of surgery: unilateral, synchronic bilateral or sequential bilateral.

RESULTS

We found inflammation in 5.5%, chromatolysis in 61.8% and lipofuscin accumulation in 41.8% of the samples. Chromatolysis and lipofuscin were found without inflammation in 32.1%. Chromatolysis and lipofuscin accumulation were each found in 60% of the samples from synchronic bilateral sympathectomies. However, those percentages decreased between the first and second sympathectomies in sequential procedures, such that chromatolysis was found in 71.4% of first-procedure samples and 42.8% of second-procedure samples; the rates for lipofuscin accumulation changed from 64.2% to 14.2%. Although findings were unrelated to age, they did correlate with compensatory sweating, which was found in 79.7% of patients undergoing synchronic bilateral sympathectomy, 78.5% of sequential bilateral sympathectomy patients and only 56.25% of unilateral sympathectomy patients.

CONCLUSIONS

Neuronal death and lipofuscin accumulation unrelated to inflammation are evident in sympathetic ganglia from patients with PPH. Such changes are atypical for a group of patients whose mean age is 29 years, unless such lesions are the result of functional hyperstimulation. Surgery performed sequentially does not lead to overloading of contralateral T2-T3 ganglia; on the contrary, decreased injury is evident.

Metals in horseshoe crabs from Delaware Bay

We examined the concentrations of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in the eggs, leg muscle, and apodeme (carapace musculature) in horseshoe crabs ( Limulus polyphemus) from eight places on the New Jersey and Delaware sides of Delaware Bay to determine whether there were locational differences. Although there were locational differences, the differences were not great. Further, contaminant levels were generally low. The levels of contaminants found in horseshoe crabs were well below those known to cause adverse effects in the crabs themselves or in organisms that consume them or their eggs. Contaminant levels have generally declined in the eggs of horseshoe crabs from 1993 to 2001, suggesting that contaminants are not likely to be a problem for secondary consumers or a cause of their decline.

[Effect of cyclosporin and tacrolimus on lipoprotein oxidation after renal transplantation]

BACKGROUND

Cyclosporin A is a lipogenic immunosuppressor that can induce posttransplant hyperlipidaemia. Oxidation of low-density lipoprotein (LDL) has been recognized as a major atherogenic factor. Tacrolimus seems to be less lipogenic with an apparently better cardiovascular profile than CsA.

METHODS

We have studied the lipidic profile and the oxidation of HDL and LDL in 20 renal transplant patients, 12 male and 8 female, mean age 45 +/- 10 year, who where switched from CsA to tacrolimus due to CsA adverse effects. LDL were determined by ultracentrifugation. Oxidation study before and 6 months after conversion to tacrolimus was performed by adding CuSO4.

RESULTS

After conversion, systolic blood pressure (BP) decreased from 154 +/- 21 to 133 +/- 21 mm Hg (p = 0.008), diastolic BP from 97 +/- 13 to 77 +/- 15 mm Hg (p = 0.016), total cholesterol from 6.08 +/- 0.9 to 5.68 +/- 1.1 mmol/l (p = 0.02), LDL-chol from 3.29 +/- 1.01 to 2.96 +/- 0.3 mmol/l (p = 0.04) and apo-B lipoprotein from 1.42 +/- 0.28 to 1.15 +/- 0.34 mg/dl (p = 0.003). The oxidation of LDL improved after conversion: the initial dienic compounds decreased from 95 +/- 20 to 63 +/- 12 umol/g and the final DC from 207 +/- 56 to 107 +/- 35 umol/g. Lag-phase increased from 33 +/- 21 to 45 +/- 17 min (p < 0.05).

CONCLUSION

Tacrolimus has improved hyperlipidaemia in our cyclosporin previously treated patients and increased the resistance to oxidation of high and low-density lipoproteins.

[Dyslipidemia and cardiovascular risk in type 2 diabetes mellitus patients with associated diabetic nephropathy]

BACKGROUND

Diabetes patients with concomitant diabetic nephropathy are especially destined to cardiovascular complications due to the presence of microalbuminuria or proteinuria, that are potent inductors of dyslipidaemia.

METHODS

We have studied 98 type 2 diabetes mellitus patients, 61 male and 37 female, mean age 63 +/- 13 year old, all of them with overt proteinuria (above 500 mg/day), divided into 4 groups: G-I (n = 13): patients with t. cholesterol > 6.25 mmol/l treated with fibric-acid derivatives; G-II (n = 52): hypercholesterolemic patients treated with statins; G-III (n = 20): hypercholesterolemic patients with no lipid-lowering intervention; G-IV (n = 13): normocholesterolemic patients (control group). Lipidic profile, proteinuria and renal function have being compared after 1, 3 and 5 years.

RESULTS

Base-line characteristics of the patients were similar when regarding age, onset of diabetes or nephropathy. Only proteinuria was higher in statins-treated group (p < 0.05). Fibric-acid derivatives were more effective on hypertriglyceridaemia while statins were more effective lowering LDL cholesterol. A gemfibrocyl-treated patient presented a rhabdomyolysis episode. Statins were safe and well tolerated. Nine patients (19%) in G-II, 2 patients (10%) in G-III and 1 patient (7%) in G-IV achieved end-stage renal failure. Five-year cardiovascular mortality and all-cause mortality rate were 23%/23% in G-I, 13%/19% in G-II, 20%/25% in G-III and 31%/31% in G-IV. The difference was statistically significant when comparing normocolesterolemic versus statin-treated patients (p < 0.05).

CONCLUSION

Lipid-lowering therapy could probably delay but not avoid the progression of diabetic nephropathy. Since dyslipidaemia is closely related to the progression of cardiovascular disease and mortality, an aggressive lipid-lowering therapy is recommended, irrespectively of its potential effect on diabetic nephropathy.

Exposure of South Carolinians to commercial meats and fish within their meat and fish diet

There has been considerable interest in the public's exposure to a variety of contaminants through the consumption of wild fish and game, yet there is little information on consumption of commercial meats and fish, or the relationship between commercial and self-caught fish. We conducted a dietary survey in 1999 to estimate exposure levels of 464 individuals from people attending the Palmetto Sportsmen's Classic. Mean consumption was similar for beef, chicken/turkey, and wild-caught fish, and much lower for pork and store-bought fish, and still lower for restaurant fish. There were no ethnic differences in the consumption of most commercial fish and meats, although the differences for chicken approached significance. There were significant ethnic differences in consumption of wild-caught fish. Women ate significantly less of all meat types, except store-bought fish. People over 45 ate less beef than younger people, and people younger than 32 ate significantly more chicken than others. There were no significant differences in consumption patterns as a function of income, except for chicken and wild-caught fish; people with higher incomes ate more chicken than others, and people with lower incomes ate more wild-caught fish than others. When all wild-caught and commercial fish and meats are considered, there are significant differences only for ethnicity and gender. Blacks consume significantly more fish than Whites, and men consume significantly more than women.

Genetic markers in the study of Anisakis typica (Diesing, 1860): larval identification and genetic relationships with other species of Anisakis Dujardin, 1845 (Nematoda: Anisakidae)

Genetic variation at 21 gene-enzyme systems was studied in a sample of an adult population of Anisakis typica (Diesing, 1860) recovered in the dolphin Sotalia fluviatilis from the Atlantic coast of Brazil. The characteristic alleles, detected in this population, made it possible to identify as A. typica, Anisakis larvae with a Type I morphology (sensu Berland, 1961) from various fishes: Thunnus thynnus and Auxis thazard from Brazil waters, Trachurus picturatus and Scomber japonicus from Madeiran waters, Scomberomorus commerson, Euthynnus affinis, Sarda orientalis and Coryphaena hippurus from the Somali coast of the Indian Ocean, and Merluccius merluccius from the Eastern Mediterranean. Characteristic allozymes are given for the identification, at any life-stage and in both sexes, of A. typica and the other Anisakis species so far studied genetically. The distribution of A. typica in warmer temperate and tropical waters is confirmed; the definitive hosts so far identified for this species belong to delphinids, phocoenids and pontoporids. The present findings represent the first established records of intermediate/paratenic hosts of A. typica and extend its range to Somali waters of the Indian Ocean and to the Eastern Mediterranean Sea. A remarkable genetic homogeneity was observed in larval and adult samples of A. typica despite their different geographical origin; interpopulation genetic distances were low, ranging from D(Nei)=0.004 (Eastern Mediterranean versus Somali) to D(Nei)=0.010 (Brazilian versus Somali). Accordingly, indirect estimates of gene flow gave a rather high average value of Nm = 6.00. Genetic divergence of A. typica was, on average, D(Nei)=1.12 from the members of the A. simplex complex (A. simplex s.s, A. pegreffii, A. simplex C) and D(Nei)=1.41 from A. ziphidarum, which all share Type I larvae; higher values were found from both A. physeteris (D(Nei)=2.77)

Metals in feathers of sooty tern, white tern, gray-backed tern, and brown noddy from islands in the North Pacific

Levels of heavy metals are usually higher in adult than young birds because they eat larger, more contaminated prey, or because they have had longer to accumulate metals in their tissues. Further, levels of contaminants are usually less in birds nesting on remote, offshore islands than in birds breeding closer to mainland areas that are urbanized and industrialized. We examined the feather levels of arsenic, cadmium, chromium, lead, manganese, mercury, and selenium in adult sooty terns (Sterna fuscata), gray-backed terns (Sterna lunata), and brown noddy (Anous stolidus, and adult and young white terns (Gygis alba, from Midway Atoll, and in adult and young sooty terns and adult brown noddy from Manana Island, Hawaii (chicks of other terns were not available). We tested and rejected the null hypotheses that metal levels are not significantly different among species, ages, and locations. Despite their small size, adult white terns had the highest levels of lead, arsenic and tin. Brown noddies had the highest levels of cadmium, chromium, manganese, and selenium. Sooty and white terns had the highest levels of mercury. Sooty tern adults had significantly higher levels of cadmium, mercury, and selenium than young, while young had significantly higher levels of arsenic and manganese. White tern adults had significantly higher levels of selenium and tin than young, while young had higher levels of cadmium and mercury than adults. Except for mercury, there were significant inter-location differences within species in all heavy metals. Contrary to expectation, where the differences were great, metals generally were higher in the feathers of terns and noddies from Midway than from Manana.