Head and neck paragangliomas.

Head and neck paragangliomas (HNPGL) are rare, slowly growing tumours, presenting as a painless mass in the neck. Multiple genetic mutations are associated with HNPGL; screening can have an important role in patients of a young age and/or with a positive family history and/or malignant HNPGL. The choice of treatment should be made individually, based on the patient's condition, the risk of complications and the aim of therapy. Observation can be a logical choice given the low incidence of malignancy. In the case of intervention, surgery and radiotherapy show comparable results for local control. For definitive eradication, surgery would be the treatment of choice, involving however high risks of complications.

Effect of three consecutive meals on the physicochemical properties of HDL and LDL in individuals with the metabolic syndrome and patients with type 2 diabetes.

BACKGROUND/OBJECTIVES: Postprandial hyperlipidemia, which is exaggerated and prolonged in insulin-resistant individuals, has been associated with cardiovascular disease. The objective of this study was to investigate whether and how the composition, size and function of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles are affected in the postprandial state among males with the metabolic syndrome (MetS) or type 2 diabetes (T2DM), compared with controls. SUBJECTS/METHODS: A total of 14 males with T2DM, 14 with the MetS and 14 age-matched controls were given three standardized high-fat mixed meals (900 kcal; 50-g fat, 75-g carbohydrate and 35-g protein) as breakfast, lunch and dinner. Blood sampling was performed just before each meal, and 4 and 8 h after the last meal. HDL and LDL were isolated by ultracentrifugation and analyzed for their composition, particle diameter and functional properties. RESULTS: Postprandial triglycerides levels in plasma, HDL and LDL particles increased significantly in all groups (P<0.01). Compared with the control subjects, patients with T2DM had smaller LDL particles, and in agreement, a lower cholesterol-to-protein content in both fasting and postprandial samples. A prolonged increase in susceptibility of LDL to oxidation was found in all subjects, but was most evident in T2DM. The postprandial effect on LDL oxidation was associated with an increase in LDL triglyceride (r=0.29, P<0.05). In T2DM the anti-oxidative capacity of HDL trended to impairment after the third meal. CONCLUSIONS: Postprandial increases in triglycerides, especially in T2DM, are accompanied by pro-atherosclerotic functional changes in HDL and LDL particles.

Is pseudocholinesterase activity related to markers of triacylglycerol synthesis in Type II diabetes mellitus?

Hypertriglyceridaemia is a risk factor for cardiovascular disease in patients suffering from Type II diabetes mellitus, and is due to enhanced synthesis and/or impaired clearance of triacylglycerol-rich lipoproteins. In the present study we investigated whether pseudocholinesterase (PChE) activity could serve as a marker for the rate of triacylglycerol synthesis in these patients. Patients were stratified according to their apolipoprotein E (apoE) phenotype, i.e. E3E2, E3E3 or E3E4. In study I, the relationship between PChE activity and serum triacylglycerols was investigated in 224 insulin-treated patients with Type II diabetes. In study II, which had a cross-over design, PChE activity was measured in 45 dyslipidaemic, insulin-treated patients with Type II diabetes that were treated with bezafibrate or pravastatin. In study I, PChE activity was correlated positively with serum triacylglycerol concentrations, but did not differ significantly between apoE phenotypes. The strongest relationship was found in the E3E4 group (r=0.50; P=0.001), the phenotype for which hypertriglyceridaemia is expected to be the result of increased triacylglycerol synthesis. In a stepwise multiple regression analysis, serum triacylglycerol concentrations were found to be the strongest predictor of PChE activity in the E3E4 group. In study II, PChE activity decreased as a result of bezafibrate treatment in all three apoE groups. The decrease in PChE activity with bezafibrate treatment paralleled the decrease in serum triacylglycerol concentrations in the apoE subgroups. Pravastatin treatment did not significantly affect PChE activity. Thus the present study suggests an association between PChE activity and the rate of triacylglycerol synthesis. Measurement of PChE activity may therefore be a useful tool in the choice of drug for treatment of hypertriglyceridaemia in patients with Type II diabetes.

Pravastatin compared to bezafibrate in the treatment of dyslipidemia in insulin-treated patients with type 2 diabetes mellitus.

BACKGROUND: Both HMG-CoA reductase inhibitors and fibric acid derivates are used for the treatment of dyslipidemia in Type 2 diabetes patients. The aim of this study was to compare the lipid lowering effect of 40 mg pravastatin, a HMG-CoA reductase inhibitor, and 400 mg bezafibrate, a fibric acid derivate, on serum lipids, lipoproteins and lipoprotein composition in 45 (22 men and 23 women) dyslipidemic, insulin-treated Type 2 diabetes patients. METHOD: The study used a double-blind, cross-over design. RESULTS: Pravastatin treatment was more effective in reducing total cholesterol, LDL-cholesterol, LDL-triglycerides, LDL-ApoB and LDL/HDL-cholesterol ratio (all p<0.001 between groups) and total/HDL-cholesterol and ApoA1/LDL-ApoB ratios (both p<0.01) and always induced a decrease in LDL-cholesterol concentrations and LDL/HDL-cholesterol ratio irrespective of baseline triglyceride concentration. Bezafibrate was more effective in increasing HDL-cholesterol (p<0.01 between groups), ApoA1 lipoprotein and decreasing triglycerides (both p<0.001 between groups) but induced an increase in LDL-cholesterol concentration particularly in patients with baseline triglyceride concentrations exceeding 2.0 mmol/l. With bezafibrate treatment the LDL-cholesterol/LDL-ApoB ratio showed a tendency to rise, suggesting a change in the LDL particle composition to a less small and dense form, while pravastatin treatment induced a decrease in this ratio suggesting a change in the LDL particle to a more dense form. With pravastatin treatment a small rise in HbA(1c) was observed. CONCLUSION: Pravastatin treatment is superior in lowering cholesterol-enriched lipoprotein subpopulations and improving cardiovascular risk factors. Bezafibrate is more effective in raising HDL-cholesterol and alters LDL particle composition to a more favorable form.

[Effective intraoperative identification of parathyroid adenomas by means of a gamma probe after injection of technetium 99m-sestamibi in 5 patients]. / Effectieve intraoperatieve detectie van een bijschildklieradenoom met een gammaprobe na injectie van technetium-99m-sestamibi bij 5 patiënten.

Primary hyperparathyroidism is caused by a single adenoma in the majority of patients. In five patients (2 men aged 74 and 78 and 3 women aged 78, 58 an 73 years) a recently introduced approach for intraoperative identification of pathological parathyroid glands was applied using intravenously injected technetium-99m(99mTc)-sestamibi and a gamma probe. For two patients this was a reoperation in this region. All patients had one adenoma removed and became normocalcaemic postoperatively. The time between the start of the operation until the extirpation of the adenoma was 13-25 min, a lot shorter than bilateral cervical exploration takes, even in the two reoperations. These results confirm the literature that this approach minimizes operative intervention, thereby shortening operative time and reducing potential surgical complications.

Pravastatin in diabetes-associated hypercholesterolemia.

Patients with diabetes mellitus (DM), type 1 and type 2, have an increased risk of coronary heart disease as a result of accelerated atherosclerosis. Dyslipidemia, often found in these patients, plays an important role in this process. This study investigates the efficacy and safety of lipid-lowering therapy with pravastatin, a 3-HMG-Coenzym A reductase inhibitor in hypercholesterolemic type-1 and type-2 diabetic patients. Of 49 patients (22 type-1 DM and 27 type-2 DM), 24 patients were treated with pravastatin, 20 mg/day, and 25 patients with placebo. After 24 weeks, total cholesterol (TC) was decreased by 22.2%, low-density lipoprotein (LDL) cholesterol by 25.8% and triglycerides (TG) by 13.6%. Pravastatin treatment did not induce a significant change in high-density (HDL) cholesterol levels. No differences in effects of pravastatin treatment on serum lipids and lipoproteins were found with respect to the diabetes type. No serious side effects occurred and pravastatin treatment did not cause any deterioration in glycemia control. The data suggest that pravastatin is effective and safe in the treatment of dyslipidemia in both type-1 and type-2 diabetic patients.

Peritonitis, moderate ascites and hepatitis due to infection with Chlamydia trachomatis and Epstein-Barr virus in a young woman. Diagnosis by polymerase chain reaction from peritoneal tissue.

Perihepatitis with ascites is a well-known presentation of pelvic inflammatory disease due to Chlamydia trachomatis. Diagnosis is based on the presence of IgM antibodies or positive culture from cervical samples or ascites. We describe a young woman with a concomitant infection of C. trachomatis and Epstein-Barr virus presenting with fever, hepatitis and ascites. Cultures remained negative and other tests were--at first--inconclusive. Diagnosis was ultimately established by polymerase chain reaction (PCR) and RNA in situ hybridisation of peritoneal tissue obtained at laparoscopy.

The efficacy and safety of pravastatin, compared to and in combination with bile acid binding resins, in familial hypercholesterolaemia.

Forty patients with familial hypercholesterolaemia (FH) were treated with 40 mg pravastatin once daily. Pravastatin decreased serum total and low density lipoprotein cholesterol (LDL) after 8 weeks of treatment by 28% and 33%, respectively, while high density lipoprotein cholesterol increased by 8% and triglycerides decreased by 14%. In 30 patients LDL cholesterol had not decreased below 5.0 mmol l-1 after 8 weeks of treatment, and in these patients resins were added to pravastatin, resulting in an additional decrease in total and LDL cholesterol of 8% and 12%, respectively. A control group of 22 FH patients was treated with placebo for 10 weeks, after which time resins were added, and they induced a decrease in total and LDL-cholesterol of 17% and 22%, respectively. Our results over a 24-week treatment period indicate that 40 mg pravastatin is more effective than 3 packets of resins in lowering LDL cholesterol, whereas the combination is most effective of all and can be used safely.

Cryptococcal meningo-encephalitis after prolonged corticosteroid therapy.

We present a case of a 69-yr-old woman who developed cryptococcal meningo-encephalitis after 9 yr of corticosteroid therapy. The diagnosis was made on an India ink preparation and positive culture of the cerebrospinal fluid sediment. NMR-imaging was a useful tool for detecting intracerebral localisation of the infection. The patient was successfully treated with amphotericin B and flucytosine for 6 wk and with itraconazole for another 8 wk.