Composition of plasma fatty acids and non-cholesterol sterols in anorexia nervosa.

Anorexia nervosa is a model of simple starvation accompanied by secondary hyperlipoproteinemia. The pattern of plasma fatty acids influences the levels of plasma lipids and lipoproteins. The concentration of plasma lathosterol is a surrogate marker of cholesterol synthesis de novo, concentrations of campesterol and beta-sitosterol reflect resorption of exogenous cholesterol. The aim of the study was to evaluate fatty acids in plasma lipid classes and their relationship to plasma lipids, lipoproteins, cholesterol precursors and plant sterols. We examined 16 women with anorexia nervosa and 25 healthy ones. Patients with anorexia nervosa revealed increased concentrations of total cholesterol, triglycerides, HDL-cholesterol, campesterol and beta-sitosterol. Moreover, a decreased content of n-6 polyunsaturated fatty acids was found in all lipid classes. These changes were compensated by an increased content of monounsaturated fatty acids in cholesteryl esters, saturated fatty acids in triglycerides and both monounsaturated and saturated fatty acids in phosphatidylcholine. The most consistent finding in the fatty acid pattern concerned a decreased content of linoleic acid and a raised content of palmitoleic acid in all lipid classes. The changes of plasma lipids and lipoproteins in anorexia nervosa are the result of complex mechanisms including decreased catabolism of triglyceride-rich lipoproteins, normal rate of cholesterol synthesis and increased resorption of exogenous cholesterol.

[Vasopressin and its analogues in the therapy of shock]. / Vazopresin a jeho analoga v lécbe sokových stavu.

Hemodynamic support during the circulatory failure with vasodilation, most frequently during the septic shock, is based on volume recovery and administration of inotropic drugs. If such therapy is not sufficient, vasoconstriction drugs are subsequently or parallel added to maintain the perfusion pressure. As a standard therapy, norepinephrine or other catecholamines with alpha-adrenergic effect are used in rising doses. Some patients do not respond to such therapy with desired hemodynamic changes--they develop catecholamine resistant shock. Because of serious side effects of high doses of catecholamines, alternative vasopressors are necessary. Vasopressin, antidiuretic hormone, has in physiological conditions only minimal effect of the vascular tone. During hypovolemia its concentration rises and it may significantly contribute to the maintenance of arterial pressure by vasoconstriction. Contrary to it, during septic shock the levels of vasopressine are very low and vasodilation clinically dominates. At the same time, the septic shock is accompanied by an increased sensitivity to vasopressin administration. In a critical shock a serious deficit of endogenous vasopressin is expected. At present several pilot studies with vasopressine administration in septic shock exist in literature describing beneficial effect of vasopressin on hemodynamic parameters. Such comparatively low doses have no side effects on perfusion and function of body organs. Terlipressin, which is available in Czech Republic, is a synthetic analogue of vasopressin with extended effect. Its intermittent administration is used for the treatment of portal hypertension complications. Terlipressin in animal model of septic shock has similarly beneficial effects as vasopressin. High doses of Terlipressin have, similarly to vasopressin, adverse effects on pulmonary circulation and other systems. Till present, only casuistic experience has been published with low doses of Terlipressin in the treatment of septic shock resistant to catecholamines, which has shown similar effects to vasopressin. In shock states with the deficit of endogenous vasopressin, which are resistant to high doses of catecholamines, administration of vasopressin analogues represents a new perspective therapy. The treatment should be studied from the point of morbidity and mortality. A careful approach has to be used in septic patients with pre-existing obliterative vassal disease.

[Acute liver failure related to the syndrome of exertional heatstroke]. / Akutní jaterní selhání vzniklé v souvislosti se syndromem ponámahového prehrátí.

Heatstroke syndrome is a well-described state, which usually occurs in areas with warm climates. Two forms are commonly distinguished: the exertional and the classic heatstroke. Increased serum levels of liver enzymes are often detected in this condition. However, acute hepatic failure following exertional heatstroke is rare. We report a case of a 30 years old man with exertional heatstroke, acute hepatic failure, serious coagulation impairment and a rhabdomyolysis following ten kilometers run. Acute hepatic failure completely developed the forth day of hospitalisation. On the fifth day, the patient fulfilled London criteria for liver transplantation and was referred to the transplantation center for the optimal management assessment. After the conservative management of acute phase, spontaneous recovery of liver functions occurred and the patient finally was not transplanted. 23 days after admission to the hospital, the patient was discharged with residual cholestasis and was followed up on outpatient basis. Serum levels of liver enzyme returned to the normal 3 months after the liver injury. In several cases, the liver failure following heatstroke is reversible and conservative management can be successful. Additionally, in 3 reported cases, emergency liver transplantation for acute hepatic failure due to heatstroke with renal failure and coma showed very poor outcome. Our case demonstrates that conservative management even in patients fulfilling accepted criteria for emergency liver transplantation can be effective and should be considered in similar condition.

Tobacco use amongst high school students in the Czech Republic.

OBJECTIVE: We were interested in the prevalence of smoking amongst teen-age students, its possible causes, and their understanding of its associated health risks. METHODS: We constructed a questionnaire that was responded to by a total of 419 students from 5 high schools in Prague, Czech Republic. Students were classified as non-smokers, mild (1-10 cigarettes daily), moderate (11-20 cigarettes daily), and severe smokers (>20 cigarettes daily). The survey also contained questions about passive smoking, motivation for smoking, the understanding of its associated health risks, alcohol consumption, and drugs. RESULTS: We found that amongst 16-20 years old high school students there are 37.5% smokers (38.0% men, and 37.0% women). The majority are mild smokers (82.3%), 15.8% moderate smokers and 1.9% heavy smokers. 29.0% of non-smokers reported passive smoking; i.e. that 65.7% of students are exposed to harmful effect of tobacco smoke. The average onset of smoking is at 14 years of age. The youngest smoker started smoking at the age of 5 years. Parents of 52.0% of students smoke (69.4% of smokers and 41.6% of non-smokers). Most of students know about the risk of lung cancer and cardiovascular diseases (86-99%). CONCLUSIONS: The prevalence of active and passive smoking among high school students is high. Parents smoking is significantly more frequent in teen-age smokers than in non-smokers. We consider the "teen-age" population together with their parents to be the key target for a successful antismoking campaign.

[Lipid metabolism in anorexia nervosa]. / Metabolizmus lipidu u mentální anorexie.

BACKGROUND: Anorexia nervosa is a model of simple starvation accompanied by secondary hyperlipoproteinemia. Plasma fatty acid pattern influences levels of plasma lipids and lipoproteins. Level of plasma lathosterol represents a marker of cholesterol synthesis de novo; levels of plant sterols reflect resorption of exogenous cholesterol. The aim of the study was to evaluate fatty acids in plasma lipid classes and their relationships to plasma lipids, lipoproteins, lathosterol, campesterol and beta-sitosterol. METHODS AND RESULTS: We examined 16 women with anorexia nervosa and 25 matched controls. Main lipid classes were separated by thin-layer chromatography, fatty acids and non-cholesterol sterols were evaluated by capillary gas chromatography. Patients with anorexia nervosa revealed increased concentrations of total cholesterol, triglycerides, HDL-cholesterol, campesterol and beta-sitosterol; changes in plasma levels of lathosterol did not reach statistical significance. The most consistent finding in fatty acid composition was a decreased content of linoleic acid and raised content of palmitoleic acid in all lipid classes. CONCLUSIONS: Changes of plasma lipids and lipoproteins in anorexia nervosa result from complex mechanisms including increased synthesis of triglyceride-rich lipoproteins along with unchanged cholesterol synthesis rate. Hypercholesterolemia in anorexia nervosa may also result from increased resorption of exogenous cholesterol.