Lipid lowering therapy with fluvastatin and pravastatin in patients with HIV infection and antiretroviral therapy: comparison of efficacy and interaction with indinavir.

BACKGROUND: Lipoprotein disorders in HIV-positive patients receiving highly active antiretroviral therapy (HAART) are becoming a major concern in HIV treatment, since there is growing evidence for an association between HAART-induced hyperlipidemia and increased cardiovascular risk. Yet relatively few data are available on the possible interactions of HAART and treatment with statins. PATIENTS AND METHODS: In this prospective study, 25 HIV-positive, treatment-experienced patients (five female, 20 male, all Caucasian) were treated with either fluvastatin or pravastatin. Total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) levels, and serum triglycerides were determined at regular intervals, as well as therapeutic drug monitoring to assess possible drug interactions. RESULTS: In 13 pravastatin-treated patients, a decrease in total cholesterol levels (from 7.12 mmol/l to 6.29 mmol/l) after 12 weeks of therapy was seen. In 12 patients treated with fluvastatin, a permanent reduction of total cholesterol (from 6.46 mmol/l to 5.31 mmol/l) after 12 weeks was observed. The reduction of LDL levels was 30.2% in the fluvastatin group and 14.4% in the pravastatin group. In eight patients receiving an indinavir-containing HAART, indinavir plasma levels were not significantly influenced. No effect on triglycerides or HDL was observed. CONCLUSION: Fluvastatin and pravastatin are efficient in lowering total and LDL cholesterol levels in HIV-positive patients receiving HAART. Furthermore, no influence on indinavir plasma levels could be observed. Therefore, both compounds seem to be a viable treatment option in HAART-induced hypercholesterolemia.

[Unwanted side-effects in using mesalazine (5-aminosalicylic acid) during radiotherapy]. / Unerwünschte Nebenwirkungen bei Anwendung von Mesalazine (5-Aminosalicylsäure) unter Strahlentherapie.

In a prospective randomized placebo controlled double blind study, the prophylactic effect of mesalazine (5-aminosalicylic acid. 5-ASA) as suppositories (3 x 250 mg/day) on radiation induced proctitis during radiotherapy for prostatic carcinoma was studied. The study ended when 16 patients had been included (5-ASA: eight, placebo: eight) because of severe side effects in the 5-ASA group. 75% of patients treated with 5-ASA reported symptoms of a severe proctitis while only one patient in the placebo group had similar complaints. The application of mesalazine as suppositories is not useful in preventing radiation induced proctitis during radiotherapy of prostate carcinoma.

A case of pneumonia caused by Legionella pneumophila serogroup 8 in West Germany. Etiological diagnosis by immunofluorescence, enzyme immunoassay, and immunoblot.

The severe and complicated course of a Legionella pneumonia in an 18-year-old female patient is reported. The serogroup 8 of Legionella pneumophila was identified as the infecting agent for the first time in West Germany. The etiological diagnosis was confirmed by immunofluorescence, enzyme immunoassay, and immunoblot. We emphasize the importance of serological testing of all Legionella pneumophila serogroups available.

[Immunogenetic findings in Crohn disease, ulcerative colitis and gluten sensitive enteropathy]. / Immungenetische Befunde bei Morbus Crohn, Colitis ulcerosa und glutensensitiver Enteropathie.

Immunogenetics explain the influence of genetic dispositions and regulation mechanisms on the defence mechanisms of organisms. In this paper the interrelationship between immunogenetic findings and Crohn's disease, ulcerative colitis and glutensensitive enteropathy are presented. The association with HLA-antigens and the complement factors Bf and C 4 are described. An increased association of HLA-antigens with Crohn's disease and ulcerative colitis have not been observed, with one exception, the association between HLA-Bw 35 (53%) and ulcerative colitis in a particular ethnic group in Israel. In contrast, there is a distinct association between the complement allotype Bf-F and Crohn's disease (68%) and ulcerative colitis (50%), compared with controls (29%). Glutensensitive enteropathy shows no increased occurrence of complement factors however there is an association with HLA-B8 (83%) DR 3 (94%) and DR 7 (61%). The phenotype description of the genes of the main histocompatibility complexes allows, amongst others, a conclusion concerning the pathogenesis and diagnosis of certain diseases. A new approach to these diseases has been introduced.

[Icterus - in intensive care]. / Ikterus - bei intensivmedizinischer Betreuung.

Jaundice is often the first and also most prominent sign of liver disease. A knowledge of liver involvement in systemic and extrahepatic disease is of practical significance for a precise diagnosis and specific therapy. Since this syndrome is complex with multifactorial causes, the following classification has been employed. Jaundice in heart failure, drug-induced jaundice, jaundice resulting from infection, postoperative jaundice. In the discussion the following points have been emphasized. A pattern of jaundice similar to hepatitis can be observed even in isolated left heart failure. Tetracyclines are able to cause an acute fatty liver with jaundice. Clostridia infections should always be considered in the case of raised indirect bilirubin postoperatively. Cautious waiting is indicated initially in the case of "benign postoperative cholestasis".

[Gluten-sensitive enteropathy--in the light of new clinical and pathogenetic aspects]. / Glutensensitive Enteropathie - im Lichte neuer klinischer und pathogenetischer Aspekte.

The corn protein gluten causes the gluten-sensitive enteropathy in susceptible persons (HLA-antigens). The diagnosis is made on the basis of the morphological criteria of villous atrophy of the jejunal mucosa and the clinical observation that the malabsorption can be healed by a gluten-free diet. The disease, which occurs in children and adults, is a distinct entity. Life-long adherence to a gluten-free diet is difficult. Intentional or unintentional reintroduction of gluten often causes masked disease states. These are best classified on the basis of electron-microscopy study of the jejunal biopsy. We propose a new classification of the phases of remission. A group of diseases exist which are closely related to gluten-sensitive enteropathy. Frequently villous atrophy is detectable. However, the disease does not respond to a gluten-free diet. The pathophysiology of these diseases is at present unclear. Diseases involving autoimmune processes also appear to be associated with gluten-sensitive enteropathy. The common factor is probably an immuno-genetic defect. This is supported by the existence of common HLA-antigen constellations. Gluten has been characterised in vitro as a lectin with oligomannose specificity. This provides a new pathomechanism for the gluten induced enterocytic destruction.

The lectin properties of gluten as the basis of the pathomechanism of gluten-sensitive enteropathy.

The pathogenesis of gluten-sensitive enteropathy is as yet unknown. According to one theory gluten may act as a lectin with toxic properties for the intestinal cells. We can now confirm this theory by laser nephelometric measurements and demonstrate the oligomannosyl specificity of this lectin-like protein gluten. Furthermore, we demonstrate the highly more intensive binding capacity of gluten for the glycoproteins of the immature crypt cells of the intestinal brush border compared to those from the mature villous zone. It is discussed that gluten-sensitive enteropathy is caused by a genetically determined defect-glycosylation of intestinal glycoproteins with the synthesis of more mannosylated glycoproteins.

Follow-up of treated adult celiac disease: clinical and morphological studies.

A follow-up study of 18 patients with celiac disease is reported. Adherence to the diet, blood chemistry and serum amino acid concentration were investigated in all patients. In addition, HLA blood group typing was performed. Ten patients agreed to undergo jejunal biopsy, xylose test and X-ray of the small intestine. The jejunal mucosa showed no complete restitution even in patients on a strict diet and function tests were abnormal, too. In this study HLA typing demonstrated an association with HLA-B8, HLA-DR3, and HLA-DR7. The results of the follow-up study are discussed with special reference to therapeutic aim and definition of therapeutic success of the gluten-free diet. In addition, a case of jejunal adenocarcinoma complicating celiac disease is presented.

[Radiological changes of adult sprue (author's transl)]. / Röntgenologische Veränderungen bei Erwachsenen-Sprue.

Radiological findings of 10 adult patients with sprue were compared with histology. Patients suffering from subtotal villous atrophy were showing distinct radiological changes. The most important finding of sprue is the dilatation of the small intestine. Further typical changes are segmentations and fragmentations as well as mucous hypertrophy and the sign of moulage. In a 57-year-old female patient who was suffering from sprue for 35 years, a carcinoma of the small bowl was found and was resected during laparatomy. Sprue is a premalignant disease; therefore radiological investigations are of special importance. Therapy by a diet without gluten can reduce the radiological changes to normal, very bad changes rarely can be reduced totally. Radiological changes are not significant, but the diagnosis can be made in most cases by investigation with barium.

[Non-tropical sprue discrepancy between clinical and biopsy findings. Five years' observation of a case (author's transl)]. / Einheimische Sprue-Diskrepanz von klinischem und bioptischem Befund. Eine Verlaufsbeobachtung über fünf Jahre.

After doagnosis and establishment of an appropriate diet a 51-year-old female patient with coeliac disease, who was critically ill in the beginning, became symptomless; nevertheless, a five year follow-up study with mucosa biopsies reveals a persisting villous atrophy with hyperplastic crypts ("flat mucosa"). This discrepancy between clinical and histological findings is discussed and it is emphasized that for coeliac patients a strict adherence to a gluten-free diet and bioptic supervision of therapy are essential. Treatment aimed solely at abolishing the clinical symptoms obviously bears the risk of a persisting symptomless illness and the danger of late complications.