Abnormal plasma lipids of patients with Retinitis pigmentosa.

Retinitis pigmentosa (RP) is a hereditary retinal degeneration of unknown etiology, resulting in progressive night blindness, loss of peripheral vision, abnormal retinal pigmentation and reduced electroretinographic response. Docosahexaenoic acid (22:6 omega 3) is found in high concentration in the rod outer segment membranes of the retina. Previous reports of low 22:6 omega 3 in blood lipids or phospholipids in RP patients prompted us to evaluate the complete fatty acid (FA) profiles of plasma phospholipids (PL), cholesteryl esters, triglycerides (TG) and nonesterified fatty acids (NEFA) in ten patients with RP. In the PL fraction, we found significantly depressed levels of 22:6 omega 3, 22:5 omega 3, total omega 3, 22:5 omega 6, 22:4 omega 6 and total omega 6 polyunsaturated FA (PUFA), and elevated total saturated acids. Plasma TG showed normal levels of PUFA, normal total saturated FA and total monounsaturated FA. The NEFA fraction showed significant elevation in total saturated FA with depressed total omega 6 PUFA. Evidence is accumulating mulating that RP is associated with abnormal PUFA and lipid metabolism.

Polyunsaturated fatty acids of serum lipids in myocardial infarction.

Two groups of volunteers had blood drawn for serum analysis of fatty acids. The first group was comprised of patients admitted to the hospital with possible myocardial infarction (MI). Blood was drawn at admission and at 12, 24 and 48 hr. These patients were subsequently divided into three groups, those with MI, those without (No MI) and those taking prostaglandin inhibitors (PGI), on the basis of the cardiac enzymes, electrocardiograms and clinical history. A fourth group of Normal nonstressed people was also drawn at 0, 12, 24 and 48 hr for comparison. Fatty acid composition of phospholipids (PL), nonesterified fatty acids (NEFA), triglycerides (TG) and cholesteryl esters (CE) was determined by capillary gas chromatography (GC), and comparisons were made between the MI, No MI, PGI and Normal groups. Total NEFA were significantly elevated in patients admitted for possible MI compared with Normals. Those patients with MI had marginally higher levels of NEFA than the No MI group at each sampling time, but this difference was not statistically significant. The MI, No MI and PGI groups had significantly different fatty acid patterns in NEFA with reduced percentages of arachidonic acid (AA) than controls. The fatty acid patterns in the four lipid classes showed few significant differences comparing the MI, No MI and PGI groups. The regular use of prostaglandin inhibitors before hospitalization for chest pain was associated with a reduced frequency of MI (p less than 0.002). NEFA levels, nonesterified AA levels and fatty acid patterns in this group did not differ from those patients not taking prostaglandin inhibitors.

Visual symptoms associated with the presence of a lupus anticoagulant.

The lupus anticoagulant is an acquired serum immunoglobulin that prolongs several coagulation parameters, most notably the partial thromboplastin time (PTT). Most commonly, this condition is found in association with systemic lupus erythematosus (SLE) but may be seen with other collagen-vascular diseases and in otherwise healthy individuals. Despite the laboratory tests suggesting impaired coagulation, clinically the lupus anticoagulant has been associated with thrombosis. The authors present five patients with the lupus anticoagulant who came to medical attention because of branch retinal artery occlusion, ischemic optic neuropathy, transient visual loss, transient diplopia, or vertebrobasilar insufficiency. Eleven previously reported patients with the lupus anticoagulant and disturbed vision are also reviewed with additional findings of retinal venous occlusive disease and homonymous visual field loss. The relationship of these findings to retinopathy in SLE is discussed. Patients with the lupus anticoagulant (with or without SLE) may develop disturbances in vision due to thrombosis from a hypercoagulable state. We recommended obtaining a PTT, VDRL, and the more sensitive anticardiolipin antibody in patients with unexplained visual symptoms.

Visual paraneoplastic syndrome associated with undifferentiated endometrial carcinoma.

We report a case of visual paraneoplastic syndrome associated with undifferentiated endometrial carcinoma. This syndrome has not previously been reported with this type of tumour; it has occurred most often with small-cell carcinoma of the lung. Electroretinography and histopathological examination have consistently shown the site of injury to be the outer retina. We review the findings in the reported cases and the proposed causes of the loss of vision in this condition.