Does continuous ambulatory peritoneal dialysis induce hypercholesterolemia?

Hypercholesterolemia has been recognized as a significant risk factor for atherosclerosis and coronary artery disease. The aim of this study was to evaluate the prevalence of hypercholesterolemia and the role, if any, of type of dialysis. In 19 hemodialysis (HD) and 20 continuous ambulatory peritoneal dialysis (CAPD) subjects, body weight, body mass index (BMI), arm muscle area (AMA), total cholesterol (C), HDL and LDL fractions, triglycerides, C/HDL ratio, glycosylated hemoglobin, and apolipoproteins AI, AII, B, CII, CIII, and E were evaluated. Hypercholesterolemia was defined as cholesterol greater than 220 mg/dL and LDL greater than 150 mg/dL. Body weight, body mass index, and arm muscle area were higher (p < 0.05) in CAPD as compared with HD; so were total cholesterol, LDL, C/HDL ratio, and glycosylated hemoglobin (Hbalc). Hypercholesterolemia prevalence was 3/19 in HD and 11/20 in CAPD (p < 0.05). A relationship between Hbalc and C/HDL ratio was found in the CAPD group (r = 0.48; p < 0.05). We are greatly concerned about these metabolic effects of CAPD; therefore, we should carefully select patients to be treated by CAPD. Aggressive nutritional and pharmacological treatment for glucose intolerance and hypercholesterolemia in CAPD patients must be performed in order to reduce the incidence of coronary artery disease (CAD).

Eosinophilic peroxidase deficiency. Cytochemical and ultrastructural characterization of 21 new cases.

Morphologic, instrumental (flow cytometric), cytochemical, ultrastructural, and chromosomal studies were performed in 21 cases of eosinophilic peroxidase deficiency that were observed in an area of northeastern Italy in the last 5 years. It was found that eosinophilic peroxidase deficiency occurred with a frequency of 1 case in 14,000 complete blood counts yearly, and thus is less rare than previously thought. Eosinophils appeared morphologically normal when examined using the light microscope, but ultrastructural study disclosed several aspecific granule alterations. In the first family studied, members with partial and total deficit were identified; in all the other cases, the enzyme deficit was total (negative cytochemical reactions and absence of dimethylaminoazobenzene-positive specific granules at the electron microscope), isolated (a single affected member in each family examined), and stable (persistent at long-term follow-up). Eosinophilic peroxidase deficiency was not correlatable with any particular disease, although a nonsignificant association with allergic-type conditions was observed. Studies are in progress to examine the modality of the defect's genetic transmission, as well as problems related to possible functional alterations and correlated clinical consequences.

Spontaneous choroidal detachment and 'red-eyed shunt syndrome': two clinical entities with the same cause?

The files of four cases of spontaneous choroidal detachment were reviewed in order to demonstrate a low pressure arteriovenous (A-V) fistula as the cause. The clinical course and symptoms were compared with those described in the 'red-eyed shunt syndrome'. In one patient an A-V fistula was demonstrated by carotidography, while in another patient CT findings supported a similar aetiology. In two out of four cases the initial clinical diagnosis was a solid subretinal mass. In all cases echography demonstrated a choroidal detachment which spontaneously disappeared. A prolonged course, bilateral involvement with changing side recurrences are the characteristics of this disease.

Mean platelet volumes: facts or artifacts?

Blood samples collected after venipuncture and skin-puncture from a series of ten healthy volunteers were used to determine platelet counts, mean platelet volumes (MPVs), and platelet distribution width (PDW). Measurements were performed on untreated venous whole blood and on whole or diluted samples, with or without anticoagulants. In this study, platelet indices were significantly different in untreated venous whole blood in comparison with blood from skin puncture and whole blood with anticoagulant.

Clinical chemical indexes and severity of coronary atherosclerosis.

The present study measured triglycerides (TG), total cholesterol (TC), HDL-cholesterol (HDL-C), LDL and LDL/HDL-C, TC/HDL-C and HDL-C/TC. 100 ratios in 261 men and women undergoing coronary arteriography. The results show that TG, TC, HDL-C and LDL levels are not related to the severity of coronary artery disease (CAD). The LDL/HDL-C, TC/HDL-C and HDL/TC.100 ratios are statistically related to the severity of CAD. The LDL/HDL-C ratio appeared to be the most sensitive index for reflecting CAD of mild severity with a predictive value of 83.3% at 76.6% specificity and at 77.7% sensitivity (cut-off: 3.20). Average values of LDL and HDL-C alone are not reliable indices of mild severity CAD.