Lipoprotein (a): its role in childhood thromboembolism.

PURPOSE: Elevated lipoprotein (a) [LP (a)] concentrations are independent risk factors of coronary heart disease or stroke in young adults. To clarify its role in childhood thromboembolism, Lp (a) was measured in 72 children with thromboembolism. METHODS: In addition to Lp (a), defects of the protein C anticoagulant system, antithrombin, and antiphospholipid antibodies were investigated in children with arterial (n = 36) or venous (n = 36) thrombosis. RESULTS: Enhanced Lp (a) >50 mg/dL was diagnosed in 8 out of 36 children with arterial and 5 out of 36 patients with venous thrombosis. Of the 72 children, 25 showed the factor V Leiden mutation, 10 showed protein C deficiency, 2 showed antithrombin deficiency, and 4 showed primary antiphospholipid syndrome. Three children with increased Lp (a) were heterozygous for the factor V Leiden mutation, and 1 girl showed additional protein C deficiency. CONCLUSIONS: Data of this study indicate that increased concentrations of Lp (a) play an important role in childhood thrombosis.

[Paraproteins and lymphoma in HIV positive patients]. / Paraproteine und Lymphome bei HIV-positiven Patienten.

BACKGROUND AND AIM: Compared to healthy subjects there is a higher incidence of monoclonal immunoglobulins (= paraproteins = PP) in patients infected with the human immunodeficiency virus (HIV). High-grade B-cell non-Hodgkin's lymphomas (NHL) are the second most common neoplasms in these patients. Our aim was to determine whether paraproteins would be of diagnostic significance regarding an underlying or developing NHL. PATIENTS AND METHODS: The sera of 202 HIV-positive patients were tested for the presence of monoclonal or oligoclonal bands by using high-resolution-electrophoresis (HRE) and immunofixation (IFX). We also examined immunoglobulin concentrations, leucocyte count, lymphocyte count, CD4 lymphocyte count and CD4/CD8-ratio and collected clinical data. RESULTS: Paraproteins were detected in 26 (12.8%) of the patients. 84.6% of PP were IgG, in 80.7% associated with a kappa light chain. Patients with monoclonal or oligoclonal bands developed NHL significantly more often compared to those without PP (16.7% and 2.8%, respectively (p < 0.05%)). The CD4 count was significantly higher in patients with PP. There was no difference in levels of immunoglobulins, leucocyte count, lymphocyte count and CD4/CD8-ratio. The prevalence of PP was equally distributed in patients at different CDC-stages of HIV-infection. Common acute systemic infections like pneumocystis carinii pneumonia (PCP), toxoplasmosis, mycobacteriosis or cytomegalovirus (CMV) infection were not associated with paraproteins. CONCLUSION: We conclude that paraproteins could indicate the presence of a non-Hodgkin's-lymphoma.