225 ADDITION OF EQUINE CHORIONIC GONADOTROPIN TO A TRADITIONAL FOLLICLE STIMULATING HORMONE PROTOCOL FOR SUPEROVULATION OF BOS TAURUS BEEF COWS

This study examined the superovulatory responses of Bos taurus beef cows maintained in a commercial embryo transfer facility. Donors were superovulated 1 to 3 times each with either a traditional 8 injection FSH protocol (controls, n = 126) or 6 injections of FSH with the seventh or eighth FSH treatments replaced by 2 injections of eCG (treatment, n = 134). During the 5-month study, 132 donors were alternatively assigned to a control or treatment group for a single superovulation and an additional 62 animals were superovulated 2 (n = 58) or 3 times (n = 4) in a crossover design. Although 14 beef breeds were represented in the study, 87% of the cows were Angus, Red Angus, Polled Hereford, or Charolais. All donors were synchronized on Day 0 with a CIDR, 5 mg of oestradiol-17β and 100 mg of progesterone. Starting on Day 4 (p.m.), controls were injected twice daily for 4 days with descending doses of porcine FSH (Folltropin-V®, Bioniche Animal Health, Belleville, Ontario, Canada). Cows received 750 μg of cloprostenol (Estrumate®, Intervet Schering-Plough, Summit, NJ, USA) at the seventh FSH injection and the CIDR was removed at the eighth FSH injection. Based on previous experience with specific, individual animals, total FSH dose per donor ranged from 240 to 400 mg. However, 74% of treatments involved 380 mg for controls and 310 mg for treated donors that received eCG. In addition, donors that were superovulated more than once received the same FSH dose in the crossover, treatment-control design. In the treatment group, 200 IU of eCG (Pregnecol™ 6000, Bioniche Animal Health) was substituted for the seventh and eighth FSH injections. Inseminations were conducted on a timed AI basis, with one unit of semen 32 h and a second 48 h following CIDR removal. Results were analysed by ANOVA as shown in Table 1. Although more ova/embryos and unfertilized ova (UFO) were recovered in the control group, the control and treatment groups did not differ in the number of grade 1, 2, or 3 embryos or in the number of degenerate embryos. Previous superovulation studies in South America using eCG to replace the last 2 injections of FSH resulted in more total ova/embryos in Nelore cows but not heifers and in more embryos in Brangus and Sindhi cows. The mean embryo production for the control cows in this study was high and the addition of eCG in the protocol did not improve embryo production. Failure of eCG to increase the number of embryos for Bos taurus cows in this study compared with previous studies may be due to differences with Bos taurus versus Bos indicus breeds or differences in management factors between Canada and South America. The high response rate in the controls may also have contributed to the failure of any advantage of adding eCG to the treatment protocol. Table 1.Mean numbers (± SEM) of ova and embryos recovered from Bos taurus females superovulated with 2 different protocols

Monitoring the response of canine hyperadrenocorticism to trilostane treatment by assessment of acute phase protein concentrations

BACKGROUND

Acute phase proteins (APPS) include haptoglobin (Hp), C-reactive protein (CRP) and serum amyloid A (SAA). Increased Hp concentrations may be induced by endogenous or exogenous glucocorticoids in dogs.

OBJECTIVES

To assess whether control of hyperadrenocorticism (HAC) affects the concentrations of Hp, CRP, SAA, alkaline phosphatase (ALKP) and cholesterol, to determine whether these analytes can be used to assess control of HAC following trilostane treatment, and whether a combination of these tests offers a valid method of assessing disease control.

METHODS

Hp, CRP, SAA, ALKP and cholesterol were assessed in 11 dogs with spontaneous HAC before and after treatment with trilostane. Adequate control of HAC was defined as post-ACTH cortisol less than 150 nmol/l.

RESULTS

Significant reductions in Hp, ALKP, cholesterol and SAA (P<0.05) but not of CRP were found after control of HAC. Only Hp, cholesterol and ALKP were moderately informative (Se & Sp>0.7) of disease control when compared to adrenocorticotropin or corticotropin (ACTH) stimulation test. SAA and CRP were unhelpful (Se & Sp<0.7). The analysis of the combination of the analytes did not improve the correlation with ACTH stimulation test.

CLINICAL RELEVANCE

Relying on these analytes does not provide additional information over ACTH stimulation test results when assessing control of HAC treated with trilostane.

Trends of hepatitis A hospitalizations and costs associated with the hospitalization in Spain (2000-2005)

The objective of this study was to analyse data related to hospitalization, comorbidities, average stays and costs associated with the hospitalization cases of hepatitis A in Spain, during the period between 2000 and 2005. A retrospective, descriptive study of the epidemiological characteristics of hepatitis A patients admitted to Spanish hospitals was performed using, as an information source, the Minimum Basic Data Set. National hospitalization rates were calculated for hepatitis A. Comorbidities, mortality, average and median stays, and mean medical costs related to hospitalization were analysed. Costs were calculated using Diagnosis-Related Groups for the disease. The total number of hospitalized patients with hepatitis A diagnosis was 2351 subjects (rate 1.87/100,000 inhabitants). The highest rate corresponds to the group aged between 20 and 39 years (3.07/100,000 inhabitants). Some 60.1% of hospitalized hepatitis A cases were diagnosed in men. Twenty-two deaths (0.9%) out of the total of hospitalized subjects were reported. The average hospital stay caused by hepatitis A was 6.8 days. The trends in the rate of hospitalized hepatitis A cases in Spain, from the year 2000 to 2005, were not statistically significant. Differences were found neither in the hospitalization percentage, nor in the average length of stay. An increase of cost from 836,278 euro in the year 2000 to 1,272,608 euro in the year 2005 was observed. The rate of hospitalized hepatitis A subjects in Spain has not changed over the period 2000-2005. The total cost derived from these hospitalizations has increased by 52%.

Canine hyperadrenocorticism: effects of trilostane on parathyroid hormone, calcium and phosphate concentrations

OBJECTIVES

To determine the effects of treating canine hyperadrenocorticism (HAC) on parathyroid hormone (PTH), calcium and phosphate concentrations in dogs.

METHODS

Serum calcium, phosphate and PTH concentrations were analysed in 22 dogs with HAC before treatment with trilostane and at a median of 210 days after commencing treatment. Pretreatment data were compared with data from an age- and weight-matched group of hospitalised patients, and post-treatment data were compared with pretreatment data.

RESULTS

PTH and phosphate concentrations were significantly higher in dogs with HAC compared with control dogs. PTH concentrations reduced significantly with treatment, such that there was no longer a difference between the HAC and control groups. Phosphate concentrations also reduced significantly with treatment but there was still a significant difference between those in dogs with HAC and control dogs. Despite no significant difference between calcium concentrations in the pretreatment HAC and control groups, calcium concentrations increased significantly with treatment.

CLINICAL SIGNIFICANCE

These results show that adrenal secondary hyperparathyroidism resolves with treatment and suggest that increased calcium and phosphate levels have a role in its pathogenesis.

Haptoglobin concentrations in dogs undergoing trilostane treatment for hyperadrenocorticism

BACKGROUND

Increased concentrations of haptoglobin (Hp), a moderate acute phase protein, have been demonstrated in dogs with hyperadrenocorticism (HAC). Monitoring serum concentrations of Hp in hyperadrenocorticoid dogs before and after trilostane administration may provide valuable information on the response to therapy.

OBJECTIVE

The aim of this study was to measure Hp concentrations in dogs with spontaneously occurring HAC at the time of diagnosis and after treatment with trilostane.

METHODS

Serum Hp concentration was measured using an automatic biochemical assay based on Hp-hemoglobin binding and utilizing SB-7 reagent in 12 dogs with spontaneous HAC before and after treatment with trilostane (30 or 60 mg PO q 12-24 h). Post-treatment Hp concentrations were measured at the time the owner reported an improvement in clinical signs. Pretreatment and post-treatment Hp values were compared with reference values and with values from 4 healthy control dogs.

RESULTS

Two dogs with HAC had pretreatment Hp values within the reference interval; 10 dogs had moderate (n = 8) or marked (n = 2) increases in Hp concentration. After treatment with trilostane, Hp concentration remained within the reference interval (n = 2), decreased to within the reference interval (n = 3), or remained moderately increased (n = 7; 3-10 g/L). Overall, a significant decrease was observed in Hp concentration after trilostane treatment compared with pretreatment values (P <.005). Both untreated and treated dogs with HAC had significantly higher Hp concentrations (P <.001) when compared with control dogs.

CONCLUSIONS

Clinical control of HAC did not closely relate to serum Hp concentration. Further studies are required to assess whether this is because of inadequate control of disease or because a build-up of cortisol precursors or secondary effects of HAC affect Hp concentration.

Association between anatomopathologic graft disorders during reperfusion and vena cava sIL-2r in orthotopic liver transplantation

Graft ischemia-reperfusion injury during orthotopic liver transplantation (OLT) is associated with anatomic and pathologic disorders in the graft, which may cause initial dysfunction. The object of this paper was to evaluate sIL-2r as an indicator of liver damage during graft reperfusion.

MATERIAL AND METHODS

Blood samples were drawn from 20 consecutive patients who required OLT secondary to chronic end-stage insufficiency various sites (portal vein, vena cava, pulmonary artery) and during different surgical phases. Following centrifugation and storage at -70 degrees C, sIL-2r was quantitated by chemiluminescence (Immulite, EURO/DPC). In addition biopsies were graded from 0 to III according to the anatomic and pathologic findings. Base excess and ammonia were measured to evaluate the function of the new liver.

STATISTICAL ANALYSES

Parameter associations were explored using Spearman's Rho and Kendall's Tau-b methods.

RESULTS

There was a correlation between the degree of graft preservation and sIL-2R both during vena cava reperfusion (r=.0591, P=.05) and for the initial 2 hours after reperfusion (r=0.61, P=.062).

CONCLUSION

sIL-2r levels drawn from the vena cava after graft reperfusion are associated with its degree of injury.

Effect of proinflammatory cytokines (IL-6, TNF-alpha, IL-1beta) on hemodynamic performance during orthotopic liver transplantation

BACKGROUND

Proinflammatory cytokines (IL-6, IL-1beta, TNF-alpha) released during liver transplantation may affect hemodynamic stability. The aim of the present study was to analyze the association between IL-6, TNF-alpha, and IL-1beta and systemic vascular resistance during the phases of liver transplantation.

MATERIAL AND METHODS

The proinflammatory cytokines IL-6, IL-1beta, and TNF-alpha were analyzed in the blood of 20 consecutive patients who underwent transplantation. Blood samples were drawn from the pulmonary artery at serial times during surgery. Hemodynamic parameters were determined using a cardiac output monitor. Correlations between parameters were analyzed using the Spearman's rho and Kendall's tau-b methods.

RESULTS

Both in the vena cava and the pulmonary artery, significant association was observed between basal values of IL-6 during hepatectomy and systemic vascular resistance during the phases of liver transplantation: hepatectomy phase (r=.76, P=.02), anhepatic phase (r=.78, P=.03) and reperfusion phase (r=.87, P=.005).

CONCLUSIONS

Basal values of IL-6 may be considered a prognostic factor for hemodynamic performance during the phases of liver transplantation.

The proportion of beef bulls in western Canada with mature spermiograms at 11 to 15 months of age

A study was conducted to determine the proportion of yearling beef bulls that have mature spermiograms at 11 to 15 months of age, and to evaluate the relationship between semen quality traits, age, and scrotal circumference. Semen samples and data on sperm motility and scrotal circumference measurements were obtained from 1641 bulls of 14 breeds. Criteria for a satisfactory spermiogram included sperm concentration > or = 400 x 10(6)/mL, > or = 60% progressively motile sperm, and > or = 70% morphologically normal sperm. The mean scrotal circumference measurements for all bulls combined were 33.4, 34.4, 35.2, 35.8, and 35.3 cm at 11, 12, 13, 14, and 15 months of age, respectively. The percentage of bulls with matures spermiograms at 11, 12, 13, 14, and 15 months of age were 20%, 30%, 51%, 52%, and 61%, respectively. There was a high positive correlation (r = 0.9) between the number of bulls with > or = 70% normal sperm and scrotal circumference measurement. The main types of morphologic defects observed in immature bulls were proximal droplets and midpiece defects.

[Complete congenital heart block. Its natural history and evolution]

This study describes the natural history and evolution of 67 patients with congenital auriculoventricular heart block admitted in the Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, D.F. from 1944 to 1998. There were 35 (52%) females and 32 (47%) males, with mean follow up period of 93.7 +/- 104 months. Most of the patients were without structural cardiovascular disease (90%). The most frequent symptoms were dyspnea and syncope. Electrocardiograms showed a ventricular heart rate of 42.2 +/- 9 beats/minute. 85.7% of patients had a supra-Hisian complete heart block. In 31% of patients a pacemaker was implanted because syncope. Overall mortality was 4.4% and malignant ventricular arrhythmias were the principal contributors. Risk factors for mortality identified in this study were junctional escape rhythm lower than 50 beats/minute, inappropriate chronotropic response during exercise, R-R interval prolongation at night, enlargement of cardiac chambers, depressed left ventricular ejection fraction and prolonged QT interval. In all of these conditions we recommend permanent pacemaker implantation.

In vitro effect of estradiol, progesterone, testosterone, and of combined estradiol/progestins on low density lipoprotein (LDL) oxidation in postmenopausal women

OBJECTIVE

One of the mechanisms currently proposed to explain the cardioprotective effect of hormone replacement therapy (HRT) is the antioxidative property of estrogens. Considering that HRT involves the administration of an estrogen, usually combined with a progestin and sometimes with an androgen, we investigated the following in vitro: (1) the effect of estradiol, progesterone, and testosterone on the oxidation of low density lipoprotein; (2) the possible pro-oxidative effect of progesterone and testosterone on native low density lipoprotein; and (3) the possible modification of the antioxidant effect of estradiol on low density lipoprotein induced by progestins.

DESIGN

Low density lipoprotein was isolated from blood samples obtained from 20 untreated postmenopausal women and divided in multiple aliquots, each containing 0.5 mg LDL protein. In Protocol 1 (n = 10) different doses of estradiol, progesterone, and testosterone ranging from 0 to 26 micrograms/ml were tested inducing oxidation with 15 microM copper sulfate. In Protocol 2 (n = 6) we studied the rate of oxidation of low density lipoprotein incubated with progesterone or testosterone without any oxidative induction. In Protocol 3 (n = 10) we studied the concomitant effect of 15 microM estradiol with four separate progestins (progesterone, medroxyprogesterone acetate, norethindrone, and norgestrel) in different doses (0, 5, 15, and 50 microM). After incubation for 4 h at 37 degrees C, malonaldehyde was measured as a marker of low density lipoprotein oxidation. The results were expressed in mean +/- SD.

RESULTS

Protocol 1: Estradiol induced a dose-dependent decrease in malonaldehyde generation, from a baseline of 61.8 +/- 30.2 nmol/mg protein to 11.6 +/- 7.1 nmol/mg protein at the highest dose of estradiol tested (p < 0.0001). Progesterone or testosterone did not modify malonaldehyde generation. Protocol 2: Progesterone and testosterone did not show pro-oxidative action. Protocol 3: Estradiol 15 microM alone induced a 35% decrease in malonaldehyde generation, from a baseline of 75.4 +/- 25.4 to 49.3 +/- 18.8 nmol/mg protein (p < 0.0001). Norgestrel and norethindrone did not modify the antioxidant effect of estradiol (p > 0.05). Progesterone and medroxyprogesterone acetate induced a further reduction of malonaldehyde concentration to 37.2 +/- 20.8 and 38.6 +/- 18.2 nmol/mg protein, only at the highest dose tested (p < 0.02 and p < 0.01, respectively).

CONCLUSIONS

Our results demonstrate that, in contrast with the potent antioxidant effect of estradiol, progesterone and testosterone did not show any pro- or antioxidant effect on low density lipoprotein in vitro. Furthermore, progestins did not counteract the antioxidant effect of estradiol in vitro.

[Comparison of the antioxidant effect of estriol and estradiol on low density lipoproteins in post-menopausal women]

BACKGROUND

Estradiol (E2) has a potent antioxidant effect on low density lipoproteins (LDL) in vitro and in vivo, which could be important in explaining the cardioprotective effect of hormone replacement therapy (HRT) in post menopausal women. Estriol (E3), on the other hand, is a weak estrogen with low metabolic effects on different tissues, and at present no cardioprotective effect has been attributed to this steroid.

AIM

To study the antioxidant effect of E3 on LDL and to compare it with the potent antioxidant action exhibited by E2.

SUBJECTS AND METHODS

After LDL was isolated by ultra centrifugation from plasma of 12 healthy untreated post menopausal women, it was divided into aliquots containing 0.5 mg of LDL protein. Estriol and E2 in doses of 0, 1, 5, 15 and 50 microM were incubated with different aliquots of LDL. CuSO4 15 microM was added to each aliquot to induce an oxidative stress. The aliquots were then incubated during 4 hours at 37 degrees C. Malonaldehyde (MDA) was measured as a marker of LDL oxidation, and expressed as nM/mg protein.

RESULTS

(mean +/- SD): Estriol induced a dose-dependent decrease in MDA concentration (baseline 62.8 +/- 21.7; 1 microM: 61.5 +/- 23.0; 5 microM: 52.9 +/- 20.3; 15 microM 43.5 +/- 20.1 and 50 microM: 31.0 +/- 17.6 nM/mg protein; F = 92.4; p < 0.0001), reaching a mean decrease of 50.7% at the highest dose tested. Estradiol has a similar dose-dependent decrease in MDA concentration (F = 60.2; p < 0.0001), revealing a more potent effect than E3 (p < 0.05), with a mean decrease of 67.4% at the highest dose tested.

CONCLUSIONS

Our results demonstrate that estriol shows an important antioxidant action of LDL in vitro, although its effect is less potent than estradiol. These results raise the possibility that estriol could have a cardioprotective effect in post menopausal women, possibility that has not been yet demonstrated.

[Dyslipidemias in renal diseases: pathogenesis and treatment]

Patients with renal diseases like nephrotic syndrome, chronic renal failure (uremia) and renal transplantation frequently present disturbances of lipid metabolisms, however their pathogenesis is partially understood. Moreover, cardiovascular diseases are responsible for many deaths in these patients. Although the effect of the dyslipidemias in the development of atherosclerosis in renal diseases is not clear, they probably play a role. Since actually the survival of these patients is substantial, it is important to manage them appropriately with regard to their dyslipidemias. This review will examine the pathogenesis and treatment of dyslipidemias in patients with nephrotic syndrome, chronic renal failure and renal transplantation.

[Diabetic neuropathy: thermal sensation and metabolic control in non-insulin-dependent diabetics]

BACKGROUND

The early detection of peripheral neuropathy in diabetics is important since it is the main risk factor for lower limb trophic lesions in diabetics.

AIM

To assess the relationship between feet thermal sensation threshold and metabolic control in ambulatory non-insulin-dependent diabetics.

PATIENTS AND METHODS

A random sample of 34 non-insulin-dependent diabetics followed for more than five years in a special clinic, out of 368 patients, was selected. Warmth sensation thresholds were measured in the dorsum of both feet using a MSTP-III thermostimulator. The average value of all glycosylated hemoglobins obtained during the 9.7 +/- 5.3 years of follow up for each patient was calculated. A multiple stepwise regression analysis was performed between thermal sensation as the dependent variable and glycosylated hemoglobin, fasting blood glucose, age and diabetes duration.

RESULTS

The regression model disclosed glycosylated hemoglobin as the only independent predictor of warmth sensation threshold (partial r = 0.385; p = 0.043). Fifteen diabetic patients with good metabolic control, defined as those with a mean glycosylated hemoglobin of less than 9.5%, had a warmth sensation threshold of 35.6 +/- 3.7 degrees C, whereas 19 diabetics with a had control (glycosylated hemoglobin > or = 9.5%) had a threshold of 39 +/- 3.8 degrees C (p = 0.017).

CONCLUSIONS

In this group of diabetics, there is a relationship between the severity of distal polyneuropathy and the metabolic control, assessed with glycosylated hemoglobin levels.

[The problem of obesity and its shocking characteristics in Chile]

Obesity is a disease which severely affects health associated to an increase in relative mortality. The measurement of obesity is currently performed by means of the Body Mass Index (BMI). Normal BMI values are between 20 and 24.9 kg/m2. In obese individuals a central fat distribution is associated with an increased mortality in men and probably in women when compared with a peripheral distribution. Based on studies carried out in the Metropolitan Region (Greater Santiago) in 1992, it is estimated that the prevalence of obesity in the population is near 20% in men and 40% in women, with the highest prevalence being observed in women from a low socioeconomic level. The projection of these figures to the whole country gives an estimate of 2.5 million people in Chile with an increased risk of mortality due to obesity. Since there is a lack of awareness in the Chilean population of the pathology of obesity and its consequences, the implementation of programs of prevention and treatment of this disease lead by the health authorities is of paramount importance.

[Immunologic and insulin secretion markers in non insulin dependent diabetic patients with secondary failure to oral hypoglycemic drugs]

BACKGROUND

The pathogenesis of secondary failure to hypoglycemic agents is heterogeneous. Some patients are true insulin dependent diabetics with a slow autoimmune disease suggested by their positive islet cell antibodies. Others, have an increased insulin resistance.

AIM

To assess the frequency of positive islet cell antibodies in diabetic patients with secondary failure to oral hypoglycemic agents.

PATIENTS AND METHODS

Thirty one diabetics, 16 with recent (less than six months) secondary failure and 15 with metabolically stable non insulin dependent diabetes were studied. All patients were older than 25 years old and had a body mass index of less than 30 kg/m2. C peptide levels before and at 5, 15 and 30 min after IV glucagon, islet cell antibodies using the Poly Human IgG peroxidase method and insulin sensitivity and secretion (estimated by the Homeostasis Model Assessment) were measured.

RESULTS

Patients with secondary failure had lower C peptide levels, compared to subjects with stable diabetes (basal: 1.5 +/- 0.2 and 2.8 +/- 0.2 ng/ml; 5 min: 2.4 +/- 0.3 and 5.5 +/- 0.5 ng/ml; 15 min: 1.9 +/- 0.3 and 4.0 +/- 0.6 ng/ml; 30 min: 1.6 +/- 0.3 and 3.4 +/- 0.5 ng/ml). Beta cell activity was 20.6 +/- 4.3% in patients with secondary failure and 92.2 +/- 9% in stable diabetics (p < 0.01). Insulin sensitivity was similar in both groups (48.6 +/- 6 and 42.8 +/- 3.5% respectively). Three patients with secondary failure and none with stable diabetes had positive islet cell antibodies. When comparing patients with secondary failure and positive antibodies and subjects with secondary failure and negative antibodies, the former had non significantly lower age, BMI and C peptide levels.

CONCLUSIONS

Some diabetic patients with secondary failure have positive islet cell antibodies. They should be measured in these patients to start insulin treatment precociously.

[Indicators of atherosclerosis risk. Evaluation with coronary angiography in non diabetic men with total cholesterol levels equal to or below 240 mg/dl]

We studied 90 male non diabetic patients aged between 40 and 65 years old with a total cholesterol of less than 240 mg/dl and not receiving cholesterol reducing drugs, that were subjected to elective coronary arteriography. Weight, height, blood pressure and smoking habits were recorded and a fasting blood sample was drawn to measure total and HDL cholesterol, triglycerides, apoproteins A1 and B, Lipoprotein(a) and plasma cholesteryl ester transfer activity. Arteriography disclosed coronary lesions in 54 patients. Compared to patients without lesions, the former had lower HDL cholesterol (34 +/- 9.8 vs 40.2 +/- 11.6 mg/dl) and higher total cholesterol/HDL cholesterol and apoB/apoA1 ratios. No differences were found for lipoprotein(a) and plasma cholesteryl ester transfer activity. Univariate analysis showed that low HDL cholesterol had the best predictive capacity for atherosclerosis.

[Is lipoprotein (a) a risk factor for coronary disease?]

The serum level of Lp(a) ha been defined in retrospective and cross sectional studies as an independent risk factor for acute myocardial infarction and cerebrovascular thrombotic accidents. However, recent prospective studies have found no evidences of association between Lp(a) levels and risk of myocardial infarction, therefore, current knowledge does not support the measurement of Lp(a) as a screening tool among middle age men. Further research is needed, to identify specific groups where Lp(a) may be a risk factor.

[Non-insulin-dependent diabetics with secondary failure: insulin therapy at bedtime combined with glibenclamide]

Secondary failure and the requirement is common in patients with non-insulin dependent diabetes mellitus. The combination of sulfonylureas with NPH insulin at bedtime has been proposed to avoid high doses of insulin. We treated 18 patients (2 men, age range 47-76 yr) non respondent to diet and glibenclamide, combining NPH insulin in an average dose of 0.3 +/- 0.03 U/kg BW at bedtime for 6 months. Fasting serum glucose improved from 256 +/- 11 to 132 +/- 6 mg/dl and HbA1C from 13.6 +/- 0.4 to 9.9 +/- 0.2%. Four patients achieved a good control (defined as a HbA1C < 9), 9 a fair control (HbA1C 9.1-10) and 5 persisted with a bad control (HbA1C > 10). Well controlled patients were younger, had a shorter duration of diabetes and had a non significantly higher body mass index. Fasting serum insulin and C peptide levels achieved after glucagon injection were not predictors of the metabolic response to combined therapy. Tolerance to treatment was good, without changes in blood pressure or serum lipids and with a low incidence of hypoglycemia. There was a mean increase of 3.6 kg in body weight. After 6 months of therapy, maximum achieved C peptide values after glucagon increased from 3.3 +/- 0.3 to 4.5 +/- 0.4 ng/ml. It is concluded that combined glibenclamide and NPH insulin at bedtime is useful to treat secondary failure in non-insulin dependent diabetic patients, but their response in variable and non dependent on their beta insular secretion.

[Dyslipidemic patients with coronary cardiopathy. Effect of different doses of OMEGA-3 fatty acids on serum lipids and lipoproteins]

Twenty one male patients aged 35 to 70 years, with coronary artery disease and dislipidemia refractory to dietary treatment, were assigned to three parallel groups of 7 individuals each that received a supplemental dose of 2, 4 and 6 g/day of omega-3 fatty acids during 60 days. After a 30 days wash-out period and 60 of supplementation, subjects were weighed, a dietary survey was performed, serum levels of total cholesterol and triglycerides, the lipid content of serum lipoproteins and the content of EPA+DHA in plasma phospholipids were measured. A dose dependent increase in EPA+DHA content of phospholipids and no changes in weight or nutrient intake were observed during the supplementation period. With the 6 g dose, a significant reduction in total cholesterol, with a reduction in VLDL and increase in LDL cholesterol and a decline in VLDL triglycerides was observed. With the 4 g dose a reduction in total cholesterol at the expense of VLDL and HDL cholesterol and a reduction in VLDL triglycerides but no changes in total triglycerides was observed. No changes in serum lipids were observed with 2 g dose. In patients with type IIA hyperlipidemia, a significant positive correlation was observed between DHA+EPA content of plasma phospholipids and LDL cholesterol, this correlation was not observed in patients with IIB or IV phenotypes. It is concluded that omega-3 fatty acids are ineffective as the only treatment for dislipidemias refractory to diet.

[The effect of body weight change on cardiovascular risk factors]

Changes in cardiovascular risk factors and body weight were correlated in 568 professional males from 17 to 57 years of age. Measurements of weight, height, body mass index, blood pressure and fasting levels of blood sugar, triglycerides, total and HDL cholesterol were obtained in 1980 and again in 1985. A significant correlation was found between body mass index and blood pressure, total cholesterol, total/HDL cholesterol, HDL cholesterol (p < 0.005), triglycerides (p < 0.001) and blood sugar (p < 0.05). Changes in body weight during the study period were correlated to changes in total cholesterol (p < 0.001), triglycerides (p < 0.05) and diastolic blood pressure (p < 0.005). Thus, obesity is correlated to the presence of cardiovascular risk factors. Its modification may influence development of atherosclerotic cardiovascular disease.

[Effect of dietary polyunsaturated fatty acids on the content and metabolism of glutathione in rat kidney]

The effect of dietary polyunsaturated fatty acids (PIFA) upon the content of reduced glutathione (GSH) of the kidney was studied in 32 male Wistar rats. Two equal size groups were fed diets supplemented with either 10% or 18% corn oil. Sixteen hours before death, half of each experimental group was submitted to fasting. The content of GSH and the activity of gamma glutamyl transpeptidase (GGTP) and gamma glutamyl cysteine synthetase was determined in kidney tissue. Fasting led to a reduction of GSH from 3.21 +/- 0.54 to 1.25 +/- 0.20 mumol per gm in the group fed 10%. PIFA. Equivalent figures for the group fed 18% PIFA were 3.49 +/- 0.54 and 0.49 +/- 0.08, respectively. GGTP activity increased significantly after fasting but no differences were observed according to level of PIFA intake. The exaggerated reduction of GSH during fasting after a high PIFA intake may expose the animals to risk of cell damage induced by peroxides or other oxidating agents.

[Insulin sensitivity: absence of sexual differences when expressed as a function of lean body mass]

The hyperinsulinemic, euglycemic clamp technique was used to test the hypothesis that--when expressed per kilogram of lean body mass--there is a sex-difference in peripheral insulin-mediated glucose disposal (M), as proposed in the literature. Lean body mass was assessed with tetrapolar bioelectric impedance analysis. We studied 15 normal subjects (volunteers with normal glucose tolerance and body mass indices between 20-25 kg/m2) of both sexes, 9 women and 6 men, of 2 age-groups, 20-30 year-old and 40-50 year-old. Men and women were similarly aged (33.3 +/- 3.8 and 33.3 +/- 3.8 years, respectively). Body mass indices were similar in both sexes (22.5 +/- 0.6 in women and 23.6 +/- 0.7 in men, NS) but percentages of fat mass were not (29.4 +/- 1.2 in women and 20.6 +/- 1.6 in men, p less than 0.001). As no difference in M (mg of glucose metabolized per kilogram of body weight per minute) between age-groups was found (6.4 +/- 0.8 and 6.8 +/- 1.2 mg/kg/min, NS) the data from these 2 age-groups were pooled. When M values obtained in both sexes were compared no differences were found (7.1 +/- 1.5 mg/kg/min in women and 6.3 +/- 0.6 in men, NS). Similarly, when M was expressed in function of the prevailing insulin levels attained during steady-state, M/l, no differences were disclosed (8.98 +/- 2 mg/kg/min/microIU insulin in women and 7.8 +/- 1.2 in men, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of a peripheral androgenic blockade on plasma lipoproteins in hirsutism patients]

We studied the effect of flutamide, a peripheral androgenic blocking agent, 500 mg daily for 28 days in 7 non ovulating patients with hirsutism. Total and HDL cholesterol, triglycerides, testosterone and dehydroepiandrosterone sulphate (S-DHEA) plasma levels were measured in patients and in 6 non ovulating control women of similar age and weight. Only basal HDL levels were lower in patients than in controls (40.2 +/- 1.6 vs 51.4 +/- 3.3 mg/dl, p < 0.01). A decrease in S-DHEA levels was observed after flutamide in patients with hirsutism (3.2 +/- 0.4 to 2.1 +/- 0.4, p < 0.01) which may be attributed to the lowering of cortisol clearance induced by the drug. Total testosterone and plasma lipoproteins remained stable. Thus, peripheral androgenic blockade does not modify the decreased levels of HDL cholesterol in non ovulating patients with hirsutism.

[Alcohol and the risk factors of coronary cardiopathy. A study in 571 men]

In 571 healthy professional males we correlated alcohol consumption with serum total cholesterol (C), HDL-C, triglycerides, blood sugar, cigarette consumption, body mass index and arterial blood pressure. An outstanding finding was a positive independent, correlation of alcohol consumption and serum HDL-C levels (r 0.22, p < 0.0001). Univariate analysis showed correlation of alcohol consumption with body mass index, blood pressure and total serum C, however this was dependent on age and/or body mass. No correlation was found between alcohol consumption and blood sugar or TG levels. Alcohol consumption did not identify a group of subjects with high risk factors. Consumption of more than 10 cigarettes per day decreased the strength of the association between elevated HDL levels and alcohol consumption. We conclude that a moderate intake of alcohol is associated to increased serum HDL levels with no significant change of other coronary risk factors.

[Cholestyramine in the treatment of hypercholesterolemia. Our experience in 11 cases]

Bile acid sequestrant resins are considered agents of choice in the therapy of hypercholesterolemia non responsive to diet treatment. We evaluated the effects of cholestyramine, 12 g per day during 4 weeks, in 11 adult patients with severe hypercholesterolemia. Total cholesterol decreased from 414 +/- 112 to 302 +/- 140 mg/dl (28%), LDL cholesterol from 330 +/- 122 to 226 +/- 143 (33%) and Apo B lipoprotein from 141 +/- 31 to 115 +/- 34 mg/dl (18%), p < 0.01. HDL cholesterol including fractions HDL2 and HDL3, Apo A1 and Triglyceride levels were not modified. No significant side effects on gastrointestinal function were observed. Thus, we confirm that cholestyramine is an effective therapy for severe hypercholesterolemia.

[Diabetes mellitus in chronic alcoholic liver damage]

We performed an oral glucose tolerance test and measured serum insulin levels in 38 patients with chronic alcoholic liver damage. A diabetic curve was obtained in 34% of subjects both obese and non obese. Insulin levels were elevated in comparison with normal subjects in all patients. The Turner index [(serum insulin x 100)/(blood sugar--30]) was lower than normal at all points of the GTT, suggesting a decreased insulin secretion in relation to serum glucose level. Blood glucose level at 120 min was correlated to age, serum bilirubin and prothrombin time. Thus, chronic liver damage is a risk factor for diabetes mellitus. The alteration of carbohydrate metabolism is correlated to the severity of liver disfunction. The initial pathogenic factor may be hyperinsulinism and resistance to insulin, followed by decreased secretion of the hormone.

[The effect of anti-insulin antibodies and of peptide C residual secretion on the metabolic control of diabetes type 1]

In 20 type I diabetic patients treated with conventional insulin preparations, we measured insulin antibodies and peptide C secretion. Peptide C levels 90 and 120 min after a standard breakfast correlated well with glucosylated Hb levels (r = -0.48 and -0.52, respectively). No correlation with free insulin levels was observed, in spite of a good correlation of the latter with blood glucose levels (r = -0.50 and -0.73, respectively). There was no relation between insulin antibody levels and peptide C or free insulin. Metabolic control was not affected by insulin antibodies. Insulin dose decreased in relation to the duration of the disease and reduction of body weight index and was not correlated to glycosylated Hb levels.

[Serum lipids, HDL2 and HDL3 cholesterol and apolipoproteins A1 and B as predictors of coronary artery disease diagnosed by coronarography]

Serum levels of total, HDL2 and HDL3 cholesterol, triglycerides and apolipoproteins A1 and B were compared in 100 Chilean males with (n = 80) or without (n = 20) coronary artery disease (CAD). The presence and severity of CAD was determined by an angiographic score. Discriminating power, sensitivity, specificity and positive predictive value for CAD were calculated for all variables. As an isolated factor, total cholesterol had the greatest discriminating power (p less than 0.002): 21% of patients with CAD had cholesterol levels below 200 mg/dl while no patient with cholesterol over 275 mg/dl was free of disease. Even though all cases with HDL cholesterol below 25 mg/dl belonged in the CAD group, this factor had no overall discriminating power. Total cholesterol/HDL cholesterol ratio had the greatest discriminating power (p less than 0.001) while total/HDL2 cholesterol had the best positive predictive value.

[Metabolic control of non insulin dependent diabetes mellitus in surgery]

We followed 50 type II diabetic patients undergoing various types of surgical procedures. Control of blood sugar was evaluated as percent of tests within an acceptable limit defined as 160 mg/dl in the preoperative period, 80-240 mg/dl in the early postoperative period and 80-120 mg/dl thereafter. Adequate control was present in 56% of tests in the first period, 95% in the second and 70% in the third. Only 2 subjects experienced hypoglycemia with no sequelae. No cases of ketoacidosis or hyperosmolar coma were observed. Overall mortality was 2% and complications included electrolyte alterations in 8%, acid base disturbance in 4% and infection in 16%. Thus, adequate metabolic control and low morbidity and mortality are possible in patients with type II diabetes undergoing surgery.

Complications and outcome of pregnancy in obese women

To examine the influence of obesity on obstetric performance, pregnancy outcome, and lactational performance, 163 mostly moderately obese gravidas were compared with age and parity-matched normal weight subjects. Significantly increased incidences of gestational hypertension, inadequate pregnancy weight gain, cesarean section, postpartum infections, and large-for-gestational age infants were observed in the study group. No significant increase in the incidence of diabetes, toxemia, breech presentation, postpartum hemorrhage, infant morbidity or lactational failure was noted in obese women. The mean birth weight of the infants of obese women was 163g greater than that of the control subjects; no difference was observed in infant length or gestational age. These results, while confirming that obesity is an important risk factor, suggest that methodological aspects of the previous studies may have contributed to magnify the severity of the problem.

[Formulation, preparation and evaluation of shortening, laminated and cut biscuits, for diabetic patients]

Laminated and cut cookies formulated with natural and/or artificial sweeteners as substitutes of sucrose, are presented as a new alternative of choice for persons on a restricted diet. According to data in the literature, market availability and technological and economic limitations involved in the use of pure sweeteners, four mixtures were selected for the formulation of the cookies, instead of sucrose. Their composition and relative sweetness were as follows: (table; see text) After the statistical analysis of results, formulations presenting significantly superior quality characteristics were selected. As observed, all alternatives subjected to evaluation were grade 1. A study of acceptability by diabetic patients was carried out with these products through a ranking test, in order to determine which were the formulations preferred. This revealed a significant preference for the cookies containing saccharin-sorbitol = 0.35:99.65, at a 1% level of significance. Their nutritional and caloric values, as well as the chemical composition of the selected formulations were then determined. The results showed a 10.9% decrease in caloric contribution.

Cholesterol distribution among lipoprotein fractions in patients with gout and normal controls

The relationship between gout and coronary disease is controversial. We studied the distribution of cholesterol among lipoprotein fractions separated by ultracentrifugation in a group of 29 gouty men and 34 healthy controls, matched by age, weight and serum glucose. Our results showed that patients had significantly higher serum triglycerides and cholesterol-VLDL and lower total cholesterol and cholesterol in LDL and HDL fractions. The comparison of both groups separated by weight and alcohol intake showed similar results. The cholesterol-LDL/cholesterol-HDL ratio was not significantly different between the groups. Based on these results, we conclude that our group of gouty patients may not be at greater risk of coronary disease than a similar control population.