Reduction of dietary saturated fatty acids correlates with increased plasma lecithin cholesterol acyltransferase activity in humans.

OBJECTIVE: Increased HDL-cholesterol (HDL-C) concentrations have been associated with lower coronary heart disease risk. On the other hand, dietary fats are known to influence the fatty acid profile of plasma lipids, including phospholipids that are substrates of lecithin cholesterol acyltransferase (LCAT), an important enzyme in HDL metabolism. The purpose of this study was to examine the association between the saturated fatty acid (SFA) intake and LCAT activity. DESIGN: An interventional study was performed in a monk community of 25 men. SETTING: A French monk community, South West of France. SUBJECTS AND INTERVENTIONS: The basal diet of the study cohort contained SFA in a proportion of 13.5% of their total energy intake (TEI). They were submitted to two experimental isocaloric diets containing either 8.4% of the TEI in SFA (diet A) or 11% (diet B), each lasting 5 weeks. RESULTS: The elevation of SFA in diet B was mainly obtained by decreasing carbohydrates. The only significant difference among total fats between diets A and B was the myristic acid content (0.6 and 1.2% of TEI, respectively). The elevation in SFA in diet B resulted in a significant increase of HDL-C (P<0.04), while plasma apo A-I concentration and LCAT activity both decreased (P<0.02). CONCLUSION: Altogether, these results are consistent with a negative effect of SFA on reverse cholesterol transport.

[Bronchial laser: techniques, indications, and results]. / Laser bronchique: techniques, indications et résultats.

Laser emits a light characterised by being monochromatic, phased and collimated. Since the beginning of the '80s the fibers ND-YAG laser, whose energy may be transmitted by quartz fibres, is the type principally used for therapeutic bronchoscopy. It may be used to coagulate or to vaporize endoluminal lesions. The effect looked for depends on the level of density of power selected. During rigid bronchoscopy, YAG laser is usually applied in the coagulation mode, with a weak liberation of energy. Further resection is then achieved mechanically with the rigid tube or forceps. For malignant lesions the laser has a palliative action in eliminating endoluminal tumour mass. Its use has overturned the management of progressive tracheal or bronchial asphyxia. Outside emergencies, its action can be combined with radio and chemotherapy. For benign lesions its action may be curative. The laser is however poorly adapted for extrinsic compression and for infiltrating lesions where other more appropriate endoscopic methods should be used.

[Silicone tracheobronchial endoprosthesis]. / Endoprothèses trachéobronchiques en silicone.

Silicone endoprostheses are used to replace loss of support in tracheobronchial cartilage. The main silicone stents are similar to those of the Montgomery T tube, the Westaby, Dumon and Cooper-Hood prostheses. The major indications are malignant tumours and benign stenosis after anastomotic resection or graft. All have in common a degree of narrowing greater than 50%. An initial bronchoscopy enables a precise assessment of the zone to support. The prostheses are then put in place using a rigid bronchoscope. An annual bronchoscopic review is recommended associated with clinical supervision. Their removal is simple even after being in position for a long period. A multicentre study (Marseille, Saint-Etienne, Brescia and Barcelona) report their experience of 1574 prostheses positioned in 1058 patients. The localisation was tracheal (54%), left main bronchus (21%), right main bronchus (18%). The average time in place was 1.2 years for benign tumours(maximum 6.2 years) and four months for malignant tumours (maximum 4.7 years). Complications were rare and included migrations (9.5%), granulomas (7.9%) and obstructions (3.6%). Thanks to their being well tolerated, their simplicity in handling, silicone prostheses are currently an essential choice to re-establish patency of the airways in patients presenting with benign or malignant tracheobronchial pathology.

[A rare case of severe pulmonary artery hypertension. Thrombosing pulmonary microangiopathy due to tumor]. / Une hypertension artérielle pulmonaire sévère de cause rare: la microangiopathie pulmonaire tumorale thrombosante.

We report a case of acute respiratory insufficiency with acute cor pulmonale and a fatal outcome. Right cardiac catheterisation enabled a diagnosis of precapillary pulmonary arterial hypertension to be made with a mean pulmonary arterial pressure of 61 mmHg and a pulmonary capillary pressure of 12 mHg. An autopsy was carried out and this revealed a microscopic pulmonary tumour emboli with lymphangitis carcinomatosis. In particular, it showed an association of fibrocellular proliferation at the level of the intima in the small calibre pulmonary arteries and arterioles permitting the unusual diagnosis of thrombosing pulmonary microangiomathy due to tumour. The physiopathological mechanism of this particular form of pulmonary tumour emboli is discussed; it would be secondary to an activation of the coagulation systems by the embolic tumour cells. Once activated, it is the lesions in the intima and not the carcinoma cells which generate the pulmonary arterial hypertension by vascular obstruction.

[Lingual thyroid and intra-lingual thyroglossal cyst. Apropos of 2 cases]. / Thyroide linguale et kyste thyréo-glosse basi-lingual. A propos de deux cas.

Lingual thyroid and intra lingual thyro-glossal cyst are two benign tumours of similar embryological pathogenesis respectively with the arrest in the ectopic position of the thyroid gland during its downward migration and from abnormal persistence of the thyro-glossal tract for the cyst. The occurrence of lingual thyroid is rare 1/100,000 patients and outnumbers the incidence of intra-lingual cyst which represents an estimated 2.1% of the thyro-glossal cysts or fistulas. Both lesions are a rare cause of dysphagia and dyspnoea due to oropharyngeal obstruction, and radionuclide scintigraphy combined with CT and/or MRI will establish the diagnosis. Surgical pharyngotomy with an infra-hyoid approach provides excellent access to the lesions and complete removal of the tumours.

Domiciliary nasal intermittent positive pressure ventilation in severe COPD: effects on lung function and quality of life.

The aim of this study was to determine the effect of domiciliary nasal intermittent positive pressure ventilation (NIPPV) on lung function and quality of life in hypercapnic patients with chronic obstructive pulmonary disease (COPD). Fourteen hypercapnic COPD patients in a stable clinical condition were evaluated in a prospective study of domiciliary NIPPV plus long-term oxygen therapy. Baseline data obtained during a 4 week run-in period were compared with measurements at the end of the 6 month study period. Spirometric parameters, arterial blood gas tensions, and quality of life were assessed. Quality of life was measured using the St George's Respiratory Questionnaire (SGRQ) and the French version of the Nottingham Health Profile (FVNHP). All patients completed 6 months of domiciliary NIPPV. Gastro-intestinal inflation was reported by eight patients. Daytime arterial oxygen tension and arterial carbon dioxide tension, improved after therapy. During the NIPPV study period, the total SGRQ score and impacts score both improved significantly; significant improvements were also noted in the total FVNHP score and the physical mobility, emotional reactions, and energy component scores. Domiciliary nasal intermittent positive pressure ventilation combined with long-term oxygen therapy has been found to improve blood gases in spontaneous ventilation, as well as the quality of life of patients with chronic obstructive pulmonary disease.

Isoelectric focusing (IEF) and immunofixation for determination of disialotransferrin.

OBJECTIVES: A new simplified method for detection and quantitation of disialontransferrin in serum is described. DESIGN AND METHODS: The method is based on polyacrylamide gel isoelectric focusing, direct immunofixation with a specific antibody, and measurement by computerized scanning densitometry. Disialotransferrin levels were determined in 24 teetotallers and 34 alcoholics at 3 moments during detoxification. Three groups of drinkers were arranged: group 1 (without), group 2 (with light), and group 3 (with severe hepatitis). RESULTS: The metho showed very good reproducibility and accuracy with a coefficient of variation between 5 to 8%. Alcoholic patients could be clearly separated from teetotallers, with a specificity of 100% and a sensitivity of 94%. After 12 days of alcohol withdrawal, disialotransferrin values declined in alcoholics but remained slightly high. They were not influenced by the severity of liver disease. No significant difference was found between the 3 groups. CONCLUSIONS: An easy-to-perform, sensitive, and inexpensive method has been developed to quantify disialotransferrin that can be used by laboratories almost everywhere.

Relationship between red blood cell antioxidant enzymatic system status and lipoperoxidation during the acute phase of malaria.

OBJECTIVE: To investigate the relationship between oxidative stress and aggrevation of the disease in patients with malaria. METHODS AND RESULTS: In the present study lipoperoxidation was demonstrated during the acute phase of malaria by a significant decrease in polyunsaturated fatty acids (PUFA). The lowest values of PUFA were obtained for C20:4 and C22:6, which were the main targets of reactive oxygen species (ROS) when parasitemia was higher than 1%. Similarly, plasma vitamins E and A were significantly reduced during the acute phase of malaria owing to their consumption in part as antioxidants. However, evaluation of the antioxidant enzymatic system in red blood cells of malaria patients indicated no significant difference from controls. Only superoxide dismutase activity tended to decrease when parasitemia increased. CONCLUSION: The results suggest that superoxide radicals are the main ROS produced during the acute phase of malaria, and that rejuvenation of RBC during hemolysis involving increased enzyme activities interacts to protect RBC from excessive superoxide radical production.

[Lp(a) and weight loss in obese patients]. / Lp(a) et perte de poids chez l'obèse.

High concentrations of lipoprotein (a) (Lp(a)) are associated with an increased risk of atherosclerotic vascular disease. Lp(a) synthesis is mainly under genetic control but many endocrine disturbances may modulate Lp(a) plasmatic concentrations. There is no agreement upon Lp(a) variations in patients under a hypocaloric diet. This study was undertaken to assess this point in obese females subjected to a 1100 kcal/d diet. Ninety-two obese patients (42.4 +/- 10.4 yr old, BMI 33.9 +/- 5.6 kg/m2) came once a week as out patients during 9 weeks. Lp(a) concentrations distribution was highly skewed. The threshold Lp(a) concentration for a significant cardiovascular risk is estimated at 0.3 g/l. Concentrations above 0.3 g/l were found in 29/92 patients (31%). If the patients were distributed in 2 groups according to their Lp(a) values (< or = ou > 0.3 g/l), the BMI, total cholesterol or triglycerides were not different. There were no significant correlation between Lp(a) and age, total cholesterol or triglycerides. After 9 weeks BMI and total cholesterol values decreased (-1.6 +/- 3.4 kg/m2 and -0.17 +/- 0.68 mmol/l, respectively). Lp(a) concentrations were unchanged (0.3 +/- 0.3 vs 0.3 +/- 0.3 g/l). There were no significant correlation between Lp(a) variations and age, BMI or initial Lp(a) concentrations. No significant decrease of Lp(a) could be detected even in the sub-group of patients with initial concentrations of Lp(a) > 0.3 g/l or even in a sub-group with Lp(a) > 0.7 g/l (n = 7). Under our conditions, weight loss is not associated with a decrease of Lp(a) concentrations suggesting that in a given obese a single determination is enough to assess his Lp(a)-related atherosclerotic risk.

Plasma lipids in HIV-infected patients: a prospective study in 95 patients.

The present study aimed to determine plasma lipid levels in 95 HIV-infected patients divided into four groups according to the CD4 lymphocyte counts comparatively to a control group of 20 HIV-negative normolipidaemic subjects. A relationship between lipidic abnormalities and immune or nutritional status was also investigated. The patients below 200 CD4 lymphocyte mm-3 (groups 1 and 2) had significantly lower total cholesterol than the controls. The patients below 400 CD4 lymphocytes mm-3 (groups 1, 2, 3) had significantly higher triglycerides and Lp(a) but lower LDL-cholesterol than the controls. In all HIV-positive patients, whatever their CD4 lymphocyte count, HDL-C and apoA1 were lower than in the controls. By multivariate analysis triglycerides were positively correlated to acute opportunistic infections and to interferon-alpha levels, while cholesterol was negatively correlated to TNF-alpha, and LDL-C was positively correlated to albuminaemia. The latter parameter was the only lipidic value to correlate with nutritional markers. The contamination route, or the presence of wasting, was not correlated to any lipidic disorder.

[In vivo study of the antilipoperoxidant effect of 3',5,7-trihydroxy-4'-methoxy flavone 7 rutinoside]. / Etude in vivo de l'effet antilipoperoxydant du 7 rutinoside de la 3',5,7-trihydroxy-4'-méthoxy flavone.

In 3-month-old Wistar rats carrageenan and CCl4 injected intraperitoneally induce an acute phase reaction which is characterized by a marked increase in alpha 1, alpha 2, beta serum globulins. This reaction corresponds to a large increase in these globulins in the first case and a smaller one in the second. A lipoperoxidant effect is demonstrated by the serum lipoprotein mobility as the lipoperoxidation index (in MDA units) or the decrease in serum vitamin A and E concentrations. This effect is also greater in the first case than in the second one. In the same way the lipoperoxidant effect is shown in liver microsomes but with a lower amplitude in the first case than in the second one. The treatment of rats by intraperitoneal injection of diosmine (150 mg/kg per week) during the 8 weeks which precede the injection of carrageenan or CCl4 results in: i) a marked decrease in the acute-phase reaction and a lower one in the lipoperoxidant effect, in serum; ii) a decrease in the CCl4 induced lipoperoxidant effect in liver microsomes. It may be concluded that diosmine, not injected at the same time as carrageenan or CCl4, but during the previous 8 weeks is sufficiently well distributed in the whole body to produce a marked inhibition of the acute phase reaction and a perceptible effect on lipoperoxidation. It may be considered an effective complement to the natural antioxidant defences of the organism (vitamins A and E).