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Genes Transgénicos Suicidas , Terapia Genética , Inmunoterapia Adoptiva , Linfocitos/metabolismo , Neoplasias/genética , Neoplasias/terapia , Enfermedad Injerto contra Huésped/etiología , Humanos , Inmunoterapia Adoptiva/efectos adversos , Depleción Linfocítica , Linfocitos/inmunología , Neoplasias/complicaciones , Neoplasias/inmunología , Donantes de Tejidos , Transducción Genética , Resultado del TratamientoRESUMEN
In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of pre-transplant donor's cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, or syphilis IgM positive serology test.
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Infecciones por Citomegalovirus/diagnóstico , Selección de Donante/normas , Infecciones por Virus de Epstein-Barr/diagnóstico , Trasplante de Células Madre Hematopoyéticas/normas , Hallazgos Incidentales , Sífilis/diagnóstico , Toxoplasmosis/diagnóstico , Donantes de Sangre , Consenso , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/sangre , Infecciones por Virus de Epstein-Barr/sangre , Francia , Conocimientos, Actitudes y Práctica en Salud , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Inmunoglobulina M/sangre , Sífilis/sangre , Sífilis/inmunología , Toxoplasma/aislamiento & purificación , Toxoplasmosis/sangre , Trasplante HomólogoRESUMEN
In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of common issues related to the donor: pre-transplant pregnancy and monoclonal gammopathy.
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Donantes de Sangre , Selección de Donante/normas , Conocimientos, Actitudes y Práctica en Salud , Trasplante de Células Madre Hematopoyéticas/normas , Hallazgos Incidentales , Paraproteinemias/diagnóstico , Pruebas de Embarazo , Consenso , Femenino , Edad Gestacional , Humanos , Paraproteinemias/sangre , Embarazo/sangre , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/prevención & controlRESUMEN
BACKGROUND: Health-related quality-of-life (HRQOL) assessments in research and clinical oncology settings are increasingly important. HRQOL instruments need to be rapid and still maintain the ability to capture the most relevant patient issues in a valid and reliable manner. The current study develops and validates the FACT-G7, a rapid version of the Functional Assessment of Cancer Therapy-General (FACT-G). PATIENTS AND METHODS: Oncology patients with advanced cancer (N = 533) from 11 diseases sites ranked the symptoms and concerns they viewed as 'the very most important' when undergoing cancer treatment, completed the FACT-G, and additional HRQOL measures. Oncology patients' scores were referenced across a general US population sample (N = 2000). RESULTS: We selected the highest priority cancer-related symptoms and concerns endorsed by patients for inclusion in the FACT-G7. Fatigue and ability to enjoy life were ranked the most highly. The results provide preliminary support for the FACT-G7's internal consistency reliability (α = 0.74) and validity as evidenced by moderate-to-strong relationships with expected criteria. The references for the general population are summarized. CONCLUSIONS: The FACT-G7 can be used to assess top-rated symptoms and concerns for a broad spectrum of advanced cancers in clinical practice and research.
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Fatiga/epidemiología , Oncología Médica , Neoplasias/epidemiología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Fatiga/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Encuestas y CuestionariosRESUMEN
PURPOSE: Impairment of cognitive function, a common complaint in patients receiving chemotherapy, is usually measured through neuropsychological tests. Patient self-evaluation of cognitive difficulties is an important complement to those tests. The Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) is a self-report questionnaire with potential to be used in standard clinical practice as a tool for evaluating patient's cognitive function before, during, and after chemotherapy. The purpose of our study was to conduct linguistic validation of the French version of the FACT-Cog. METHODS: Both qualitative and quantitative methods were used in this study. After undergoing a rigorous translation methodology, the French FACT-Cog version was pretested in France with 35 cancer patients undergoing chemotherapy treatment. Interviews were conducted with all patients to ascertain their understanding of each item. The validation of the final version was conducted among 63 cancer patients, and sociodemographic information was collected as well as brief measure of cognitive function and depression score. RESULTS: Patient comments obtained through the cognitive debriefing interviews indicated that patients understand the French FACT-Cog items as they are intended and that the measure is culturally appropriate. Internal consistency reliability of the subscales, evaluated using Cronbach's coefficient alpha, was high for all four subscales: Perceived Cognitive Impairments = 0.93, Impact On QOL = 0.85, Comments From Others = 0.70, and Perceived Cognitive Abilities = 0.89. All item-total correlations for each subscale were greater than 0.20, and most were greater than 0.50. CONCLUSIONS: Results from this study effectively demonstrate that the French FACT-Cog is a reliable instrument for the self-reporting of cognitive abilities in patients undergoing chemotherapy.
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Antineoplásicos/efectos adversos , Trastornos del Conocimiento/diagnóstico , Cognición , Neoplasias , Adulto , Anciano , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/psicología , Psicometría/instrumentación , Calidad de Vida , Reproducibilidad de los Resultados , Autoinforme , Encuestas y CuestionariosRESUMEN
Allogeneic hematopoietic stem cell transplantation (SCT) is a widely used, cost-intensive procedure. Although pretransplant nonmyeloablative (NMA) or reduced-intensity conditioning regimens appear very promising, prospective studies comparing this approach with the conventional myeloablative (MA) approach in specific hematologic diseases are necessary, especially in patients in whom the conventional approach is not contraindicated. Cost may be an important factor in the decision-making process. We compared the costs of MA and NMA transplants in patients with acute myeloid leukemia (AML). We estimated 1-year resource utilization in 12 consecutive MA patients (median age: 39 years) and in 11 consecutive NMA patients (median age: 58 years) who underwent HLA-identical sibling SCT for AML. Resources care expenses were valued using the average daily rate for personnel costs, supplies, and room costs. Other data were directly collected from the patients' charts. Despite a trend for lower costs in NMA patients during the first 6 months, costs during the 6-12-month period were significantly higher after NMA due to late complications and readmissions (P=0.03). Finally, mean 1-year costs were not different in MA and NMA patients (P=0.75). Prospective studies comparing conventional and NMA approaches in homogeneous populations should include economic items.
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Trasplante de Células Madre Hematopoyéticas/economía , Leucemia Mieloide Aguda/terapia , Trasplante de Células Madre/métodos , Trasplante Homólogo/economía , Adulto , Anciano , Estudios de Cohortes , Femenino , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedad Veno-Oclusiva Hepática/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Inducción de Remisión , Factores de Tiempo , Acondicionamiento Pretrasplante , Trasplante Homólogo/efectos adversosRESUMEN
Granulocyte transfusion is uncommon but essential for some aplastic patients with major infection and those with septic granulomatosis disease and visceral aspergillosis. Compatibility between donor and recipient (ABO, D, Kell blood type, cytomegalovirus) is necessary. Stimulation by dexamethasone, before use of GCSF, permits to obtain approximately 10 x 10(9) white cells per l. Doses of heparin must be calculated to ensure an efficient hypocoagulation without any trouble for the donor immediately after his donation. Sedimentation by hydroxyethylstarch is an unavoidable element to obtain the most efficient separation of granulocytes. Most donations present an amount of white cells between 2 and 4 10 x 10(10). This enables to transfuse efficiently children and adults.
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Donantes de Sangre/estadística & datos numéricos , Granulocitos , Transfusión de Leucocitos/estadística & datos numéricos , Adulto , Agranulocitosis/terapia , Anticoagulantes/administración & dosificación , Pruebas de Coagulación Sanguínea , Tipificación y Pruebas Cruzadas Sanguíneas , Separación Celular/métodos , Centrifugación , Niño , Infecciones por Citomegalovirus/epidemiología , Dexametasona/farmacología , Factor Estimulante de Colonias de Granulocitos/farmacología , Heparina/administración & dosificación , Humanos , Derivados de Hidroxietil Almidón , Leucaféresis/métodos , Recuento de Leucocitos , SeguridadRESUMEN
BACKGROUND: Rituximab induces clinical response in advanced B-cell lymphoma and is efficient in removing circulating B-cell from peripheral blood. We therefore postulated that rituximab might be a useful in vivo purging agent before high-dose therapy in this setting. PATIENTS AND METHODS: Fourteen patients with relapsed follicular, marginal zone and mantle cell lymphomas (11, two and one cases, respectively) and a PCR-detectable molecular marker were treated first with rituximab, then a mobilization chemotherapeutic regimen, followed by high-dose therapy with peripheral blood stem cell transplantation. PCR analyses were performed in peripheral blood before rituximab and during follow-up, and in harvest. RESULTS: Harvests were free of PCR-detectable molecular marker in nine of the 11 studied cases (82%). After high-dose therapy, clinical complete remission was obtained in 13 (93%) patients and molecular remission in 11 (79%). With a median follow-up of 3 years, the 14 transplanted patients were alive, 11 of them remaining in clinical complete remission and eight in molecular remission at last follow-up. CONCLUSION: Rituximab treatment followed by high dose therapy appears to be effective in achieving complete clinical and molecular response. In vivo harvest purging is predictive of prolonged clinical and molecular remission.
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Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Purgación de la Médula Ósea/métodos , Linfoma de Células B/terapia , Linfoma Folicular/terapia , Linfoma de Células del Manto/terapia , Trasplante de Células Madre de Sangre Periférica , Adulto , Anticuerpos Monoclonales de Origen Murino , Antígenos CD34/metabolismo , Terapia Combinada , Femenino , Estudios de Seguimiento , Movilización de Célula Madre Hematopoyética , Humanos , Linfoma de Células B/patología , Linfoma Folicular/patología , Linfoma de Células del Manto/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Inducción de Remisión , Rituximab , Terapia Recuperativa , Células Madre/patología , Trasplante Autólogo , Resultado del TratamientoRESUMEN
The latest generation of cell separators such as Trima (Gambro), Amicus (Baxter) and AS-TEC 204 (Fresenius), allow the collection of leucocyte-reduced platelet concentrates without secondary filtration. Fresenius has recently developed the COMTEC cell separator whose performance has been evaluated by several teams in France. This new cell separator is an improved version of the Fresenius AS-TEC 204 cell separator, designed to allow more efficient platelet collections. This study reports on the experience of six French teams (from Bordeaux, Clermont-Ferrand, Creteil, Dijon, Lille and Nancy) who obtained 696 leucocyte-reduced plateletpheresis concentrates in the course of collection using the new Fresenius COMTEC cell separator. All healthy volunteer donors fulfilled French selection criteria for platelet apheresis. Donors were eligible if they had suitable venous accesses, if their bodyweight was *50 kg and if their pre-apheresis platelet count was >150 x 10(9) l(-1). Between 4606 and 5229 ml of blood were processed. The mean volume of the platelet concentrates was between 439 and 493 ml (mean 460 +/- 63 ml). The platelet yield was of the order of 5.18 +/- 1.02 x 10(11) with only one platelet concentrate below the norm of 2 x 10(11) platelets (0.91 x 10(11)). No plausible explanation for this was found. The residual leucocyte levels conform to current norms. The platelet concentrates contained less than 1 x 10(6) leucocytes per concentrate (mean 0.233 +/- 0.150 x 10(6) leucocytes) in more than 97% of the components produced with >95% statistical confidence. The efficacy of the cell separator (52.44 +/- 7.35%) is comparable to that of other separators. The Fresenius COMTEC cell separator makes it possible to obtain leucocyte-reduced platelet concentrates which comply with current standards both in terms of platelet content and residual leucocyte level.
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Glucosa/análogos & derivados , Plaquetoferesis/instrumentación , Adulto , Anticoagulantes/efectos adversos , Donantes de Sangre , Volumen Sanguíneo , Peso Corporal , Ácido Cítrico/efectos adversos , Diseño de Equipo , Femenino , Francia , Glucosa/efectos adversos , Humanos , Depleción Linfocítica/instrumentación , Masculino , Recuento de Plaquetas , SeguridadRESUMEN
BACKGROUND: A decrease in hematocrit lengthens bleeding time. The authors studied the role of hematocrit variations in an experimental model of arterial thrombosis and bleeding. METHODS: The Folts model was used in 24 rabbits. After anesthesia was induced and common monitors were positioned, the right common carotid artery was exposed and a 60% stenosis was induced. A compression injury of the artery was then produced, which triggered a series of cyclic episodes of thrombosis and clot lysis (cyclic flow reductions [CFRs]). After counting the number of CFRs that occurred in 20 min (CFR1), the animals were assigned randomly to one of three groups (n = 8 in each group): control, hemodilution with rabbit homologous platelet-rich plasma, and hemodilution with gelatin solution and then reinfusion of the shed blood. The effect of hemodilution with replacement by platelet-rich plasma or by colloid was observed by recording the number of CFRs during another 20-min period (CFR2). A third period of observation (CFR3) followed shed blood reinfusion in the gelatin solution group. Ear immersion bleeding time was recorded after each CFR period. RESULTS: In the two experimental groups, the decrease in hematocrit (from 36 +/- 3% to 23 +/- 2% and from 38 +/- 3% to 23 +/- 2%, respectively; mean +/- SD) abolished CFRs (from a median of 4 to 0 and 7 to 0, respectively) and significantly lengthened bleeding time (from 76 +/- 24 s to 114 +/- 36 s and from 84 +/- 37 s to 127 +/- 29 s, respectively). Blood reinfusion in the group that received the gelatin solution caused CFR to reappear (CFR3 = 4). CONCLUSIONS: Decreases in hematocrit reduced the cyclic arterial thrombosis rate and increased the bleeding time in the rabbits in this study. Hematocrit normalization caused thrombosis to reappear.
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Hematócrito , Hemorragia/etiología , Trombosis/etiología , Animales , Modelos Animales de Enfermedad , Masculino , Agregación Plaquetaria , ConejosRESUMEN
BACKGROUND: Residual white cells (WBCs) cause serious side effects in platelet transfusion. An in-line WBC-reduction system based on fluidized particle bed technology was recently developed as a modification of an existing plateletpheresis system. STUDY DESIGN AND METHODS: In an investigational phase, three flow profiles were evaluated using prototype software in five centers, each using their standard conditions. In the confirmatory phase, the released software was tested in three centers. WBCs were counted in two full Nageotte grids (dilution 1-in-5). RESULTS: With the prototype software, WBC levels were always below 1 x 10(6) per procedure (median, 25,000/procedure; n = 314). One profile proved to be superior to the other two with respect to platelet yield and residual WBCs, and it was incorporated in the released WBC-reduction system, together with a built-in process control. Median residual WBCs in these WBC-reduction system components not rejected by the process control were 19,000 per procedure (n = 211/225 total), with 99.5 percent of the platelet components having less than 1 x 10(6) WBCs. CONCLUSION: The protocol selected in the initial phase, now available as a WBC-reduction system, results in platelet concentrates with very low residual WBC levels. This satisfies even the most stringent criteria for WBC reduction in platelets, without the platelet loss typically seen with conventional fiber filtration.
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Plaquetas , Leucaféresis/métodos , Recolección de Muestras de Sangre/métodos , Filtración , Humanos , Modelos Biológicos , Estudios Multicéntricos como Asunto , Programas InformáticosRESUMEN
INTRODUCTION: Normolipaemic plane xanthomatosis is classically associated with a monoclonal gammapathy. CASE REPORT: We observed this association in a 69-year-old woman. This case was particular since anti-lipoprotein activity due to a monoclonal IgG immunoglobulin was found in the serum with abnormal complement fractions. The paraproteinaemia remained stable after a 2-year follow-up. CONCLUSION: This association is remarkable. The anti-lipoprotein activity of the monoclonal protein should be emphasized in light of the immunological processes involved in the pathogenesis of this association.
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Proteínas del Sistema Complemento/deficiencia , Inmunoglobulina G/inmunología , Lipoproteínas/inmunología , Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Xantomatosis/complicaciones , Anciano , Femenino , Humanos , Lípidos/sangre , Xantomatosis/sangreRESUMEN
Autologous blood transfusion techniques have been devised in order to decrease the risk of homologous transfusion-related complications. In neurosurgery, preoperative autologous blood collection is difficult because of the rather short time interval before surgery, as well as the risk of increasing cerebral oedema or intracranial hypertension. Therefore erythrocytapheresis has been performed the day before surgery as a preoperative haemodilution in 33 patients, using a discontinuous flow cell separator (PCS + Heamonetics). Patients with anaemia, unstable cardiovascular condition, infections, malignant tumor with a bad prognosis, or a poor peripheral venous status were not included. The mean volume of collected red cells was 526 +/- 176 mL, allowing a minimal colloid perfusion adjusted on this volume, with a simultaneous restitution of plasma and platelets. For a mean peroperative estimated blood loss of 1,040 +/- 52 mL, a homologous blood transfusion was avoided in 29 patients (88%). Four patients who underwent meningioma surgery received homologous red cells units in addition to their autologous blood. Two patients did not require any transfusion. Finally, 88% of autologous red cells units were readministered and 8 units were not retransfused. Preoperative erythrocytapheresis has proven to be a very simple and well tolerated technique. It can be considered for elective neurosurgery, when the time delay before surgery is short and when the blood loss is anticipated as to be moderate. It may also be associated with iterative autologous blood donation programme or the peroperative use of a cell saver.
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Transfusión de Sangre Autóloga/métodos , Transfusión de Eritrocitos , Hemodilución/métodos , Neurocirugia , Adolescente , Adulto , Citaféresis/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios RetrospectivosRESUMEN
Familial xanthomatous hypercholesterolemia is a metabolic disorder associated with high LDL levels attributed to a familial defect in LDL receptor activity. We have previously shown that hyperlipoproteinemia of WHHL rabbits, considered to be a model for heritable hypercholesterolemia, was at least partly of exogenous origin. We have though studied retinyl palmitate (RP) levels 12 h after a standardized mixed meal as a simple test to detect abnormalities of intestinal-derived lipoprotein clearance in 22 familial hypercholesterolemic patients with xanthomatosis (13 of them treated by simvastatin, an HMGCoA reductase inhibitor, and 9 not treated), as compared to a control group (n = 12). Total and LDL cholesterol, plasma triglyceride and apo B levels were significantly higher in patients when compared to controls. Mean RP levels appeared higher in familial hypercholesterolemic patients, when compared to controls, with 6 among 22 patients showing clearly high vitamin A levels and 4 borderline values, whereas high triglyceride levels (> 2 g/l) were detected in only 1 patient. No patients within the group with high vitamin A levels showed an apo E2/E2 phenotype. Vitamin A levels correlated with plasma triglycerides in the whole group of subjects (r = 0.50, p < 0.05). No difference was observed in vitamin A distribution between treated and untreated hypercholesterolemic patients. Our results indicate that the clearance of RP-labeled intestinal lipoproteins is delayed in some xanthomatous familial hypercholesterolemic patients as compared with that of controls. These findings suggest that familial xanthomatous hypercholesterolemia may be heterogenous concerning physiopathological mechanisms inducing hyperlipidemia.
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Hiperlipoproteinemia Tipo II/metabolismo , Metabolismo de los Lípidos , Vitamina A/sangre , Enfermedad de Wolman/metabolismo , Adulto , Apolipoproteínas B/sangre , Ingestión de Alimentos , Femenino , Humanos , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/genética , Hipolipemiantes/uso terapéutico , Lípidos/farmacología , Lovastatina/análogos & derivados , Lovastatina/uso terapéutico , Masculino , Persona de Mediana Edad , Simvastatina , Triglicéridos/sangre , Vitamina A/farmacología , Enfermedad de Wolman/complicaciones , Enfermedad de Wolman/genéticaRESUMEN
OBJECTIVES: We report here 9 cases of acute viral hepatitis A leading to hospitalization between June 1989 and October 1992. The main feature was a marked and protracted cholestasis. RESULTS: Jaundice lasted an average of 77 +/- 39 days (range: 30-120) and total serum bilirubin concentrations were 265 +/- 184 mumol/L (range: 51-560). IgM anti-HAV was present in the serum for 6.3 +/- 5.5 months (median: 4, range: 2-19). Histopathological examination of the liver was performed in 6 patients and most showed intralobular cholestasis and portal tract inflammation associated with dystrophy and paucity of bile ducts. Acute renal failure was noted in one patient. In three patients, whose pruritus was not relieved by cholestyramine, plasma exchange was an effective therapy. CONCLUSION: These case reports confirm the severity of viral hepatitis A in adults and emphasize the importance of vaccination.
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Colestasis/complicaciones , Hepatitis A/complicaciones , Intercambio Plasmático/métodos , Lesión Renal Aguda/etiología , Adulto , Ácidos y Sales Biliares/sangre , Bilirrubina/sangre , Análisis Químico de la Sangre , Colestasis/sangre , Colestasis/patología , Colestasis/terapia , Femenino , Hepatitis A/sangre , Hepatitis A/patología , Hepatitis A/terapia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The risk of transfusion-related viral infections promotes techniques intended to reduce such a risk. Preoperative erythroapheresis is an autologous blood collection technique which minimizes the inconvenience of repeated predeposit autologous donations. Erythroapheresis has been performed in 451 patients, 24 to 72 hours before surgery using a discontinuous flow cell separator (PCS+Haemonetics). The mean collected red cells volume was 485 ml (250-900) and was replaced by hydroxy-ethyl-starch (ELOHES). Homologous blood transfusion was avoided in 431 patients (95,6%). This technique is indicated for surgery with an expected blood loss between 1000 and 1500 ml or when the patient cannot be included in a preoperative blood donation programme. Preoperative erythrocytapheresis is a simple and well tolerated procedure. To have recourse to apheresis techniques allows to increase the number of autologous transfused patients.
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Recolección de Muestras de Sangre/métodos , Transfusión de Sangre Autóloga , Eritrocitos , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Several reports have shown that lipoprotein(a) is associated with ischemic diseases. Two characteristics might explain this association. Firstly, Lp(a) is an LDL-like lipoprotein which may be implicated in the atherosclerotic process and secondly, Lp(a) possesses an additional apolipoprotein(a) whose structure is close to that of plasminogen and might confer to the molecule prothrombotic properties. It seemed of interest to see whether Lp(a) was a risk factor in oral contraceptive users with thrombotic complications, a group of young women with presumably little or no atherosclerosis. Three groups of women were compared: 25 of them served as controls and did not use oral contraceptives (OC) (group 1); 25 women were healthy current users of OC (group 2); 35 women suffered thrombotic complications in the course of OC (group 3). Mean levels of Lp(a), estimated by RID, were not found to be significantly different in the 3 groups: 19 +/- 18, 20 +/- 23 and 16 +/- 22 mg/dl, respectively. Levels above 30 mg/dl were similarly distributed. Among the other risk factors studied, antiestrogen antibodies were absent in group 1, present in 24% of group 2 and 71.4% of group 3 (P < 0.01). Serum cholesterol levels were similar in the 3 groups: 209 +/- 33, 220 +/- 41, 213 +/- 45 mg/dl respectively. Mean serum triglyceride levels were higher in group 2 than in group 1 (61 +/- 18 and 83 +/- 32, P < 0.01), and higher in group 3 than in group 2 (116 +/- 66 and 83 +/- 32, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)