RESUMO
Postprandial hyperlipidemia is considered to be a substantial risk factor for atherosclerosis. Interestingly, this concept has never been supported by randomized clinical trials. The difficulty lies in the fact that most interventions aimed to reduce postprandial lipemia, will also affect LDL-C levels. The atherogenic mechanisms of postprandial lipids and lipoproteins can be divided into direct lipoprotein-mediated and indirect effects; the latter, in part, by inducing an inflammatory state. Elevations in postprandial triglycerides (TG) have been related to the increased expression of postprandial leukocyte activation markers, up-regulation of pro-inflammatory genes in endothelial cells and involvement of the complement system. This set of events is part of the postprandial inflammatory response, which is one of the recently identified potential pro-atherogenic mechanisms of postprandial lipemia. Especially, complement component 3 levels show a close correlation with postprandial lipemia and are also important determinants of the metabolic syndrome. In clinical practice, fasting TG are frequently used as reflections of postprandial lipemia due to the close correlation between the two. The use of serial capillary measurements in an out-of-hospital situation is an alternative for oral fat loading tests. Daylong TG profiles reflect postprandial lipemia and are increased in conditions like the metabolic syndrome, type 2 diabetes and atherosclerosis. Studies are needed to elucidate the role of postprandial inflammation in atherogenesis and to find new methods in order to reduce selectively the postprandial inflammatory response. Future studies are needed to find new methods in order to reduce selectively the postprandial inflammatory response.
Assuntos
Aterosclerose/etiologia , Hiperlipidemias/metabolismo , Lipoproteínas/metabolismo , Período Pós-Prandial/fisiologia , Aterosclerose/metabolismo , Humanos , Hiperlipidemias/complicações , Leucócitos/metabolismoRESUMO
A 54-year-old man with chronic renal failure due to diabetic nephropathy presented with macroscopic haematuria and excretion of necrotic tissue in the urine as a sign of papillary necrosis.
Assuntos
Necrose Papilar Renal/diagnóstico , Necrose Papilar Renal/urina , Rim/patologia , Complicações do Diabetes , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , UrináliseRESUMO
In the Netherlands, brucellosis is uncommon. Diagnosis is difficult and frequently delayed. We present three patients with back pain and/or arthralgia caused by brucellosis. We emphasise the importance of considering brucellosis in patients returning from a stay in a rural area of an endemic country, who present with osteoarticular symptoms and signs of chronic inflammation. Clues to the diagnosis come from a thorough medical history.
Assuntos
Brucelose/diagnóstico , Ciprofloxacina/uso terapêutico , Doxiciclina/uso terapêutico , Rifampina/uso terapêutico , Adulto , Idoso , Artralgia/etiologia , Dor nas Costas/etiologia , Brucelose/complicações , Brucelose/tratamento farmacológico , Ciprofloxacina/administração & dosagem , Diagnóstico Diferencial , Quimioterapia Combinada , Dispneia/etiologia , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Rifampina/administração & dosagem , Turquia/etnologiaRESUMO
This report describes a patient with a massive right ventricular infarction, complicated by severe hypoxemia. Contrast echocardiography demonstrated a right to left shunt through a previously asymptomatic atrial septal defect. This phenomenon should be considered as a possible cause of hypoxemia in the presence of right ventricular infarction.
Assuntos
Comunicação Interatrial/complicações , Hipóxia/etiologia , Infarto do Miocárdio/complicações , Ecocardiografia , Eletrocardiografia , Feminino , Comunicação Interatrial/diagnóstico , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Miocárdio/patologiaRESUMO
Abrupt onset pulmonary edema, that rapidly resolves (flash edema) may be due to renal artery stenosis. We describe two patients with renal artery stenosis who experienced a life-threatening episode of flash edema. Relief of the stenosis prevented recurrence of the flash edema.
Assuntos
Edema Pulmonar/etiologia , Obstrução da Artéria Renal/complicações , Idoso , Angioplastia com Balão , Creatinina/sangue , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/tratamento farmacológico , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/terapiaRESUMO
Spontaneous hypoglycaemia in renal failure occurs more frequently than is considered generally. The pathogenesis is complex. Understanding the underlying mechanisms is of interest to all practitioners attending patients with renal failure. A case report is presented describing a patient with 'spontaneous' hypoglycaemia, without any illness other than renal failure. The various mechanisms contributing to or causing hypoglycaemia are reviewed.
Assuntos
Hipoglicemia/etiologia , Falência Renal Crônica/fisiopatologia , Adulto , Análise Química do Sangue , Glucose/metabolismo , Humanos , Falência Renal Crônica/diagnóstico , MasculinoRESUMO
A 35-year-old woman presented with extensive subcutaneous emphysema caused by trapping of air by valve-like wound edges after a minor trauma of her right olecranon.
Assuntos
Traumatismos do Braço/complicações , Enfisema Subcutâneo/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Gangrena Gasosa/diagnóstico , Humanos , Enfisema Subcutâneo/terapiaRESUMO
Two patients, a man aged 33 years and a woman aged 30, suffered from a varicella zoster induced pneumonia. In adults a varicella zoster infection may be accompanied by a very severe pneumonia. In one patient mechanical ventilation was necessary. A chest X-ray and blood gas analysis must be made in adults suffering from a varicella zoster virus infection who have pulmonary complaints. In case of abnormalities in one of these two examinations the patient must be observed in a clinical setting. The pneumonia can be treated with aciclovir.
Assuntos
Herpes Zoster/complicações , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Aciclovir/uso terapêutico , Adulto , Feminino , Herpes Zoster/sangue , Herpes Zoster/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Masculino , Oxigenoterapia , Pneumonia Viral/diagnóstico , RadiografiaRESUMO
A 67-year-old male presented with abdominal pain followed by respiratory distress. Imaging revealed a right-sided Bochdalek's hernia. At thoracotomy two days later, an incarcerated small bowel segment was removed, with a protracted post-operative course. In adults, a Bochdalek's hernia is rare and usually asymptomatic. However, when symptoms do occur, incarceration of the intestinal contents is frequent and accompanied by high mortality. The severely protracted course after delayed treatment of a symptomatic Bochdalek's hernia described here illustrates the importance of early recognition and surgical intervention.
Assuntos
Hérnia Diafragmática/complicações , Hérnia Diafragmática/cirurgia , Insuficiência Respiratória/etiologia , Toracotomia , Dor Abdominal/etiologia , Idoso , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino , Insuficiência Respiratória/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: Changes in leukocyte cell population data have been reported in various infectious diseases, but little is known in other inflammatory conditions such as the postprandial state. We investigated whether leukocyte cell population data change during postprandial leukocyte activation. METHODS: Healthy volunteers underwent a standardized oral fat loading test (OFLT). Flowcytometric quantitation of leukocyte activation markers CD11b, CD66b, CD35, and CD36, together with leukocyte cell population data from LH750 hematology analyzers were measured fasting and at 4 and 8 h postprandially. RESULTS: Twelve volunteers were included. Postprandial leukocyte activation was confirmed by increased expression of CD11b by monocytes (+11.7%) and neutrophils (+15.0%) and by increased expression of CD66b (+14.7%) and CD35 (+16.6%) by neutrophils at T = 4 h. The mean scatter from neutrophils, reflecting granularity, significantly decreased at T = 4 h (P < 0.05) and returned to baseline at T = 8 h (P-anova 0.048). The mean volume of monocytes increased significantly at T = 4 h (P < 0.001) and returned to baseline at T = 8 h (P-anova 0.0008). At T = 4 h, CD11b expression on neutrophils was associated with a reduction in mean scatter of neutrophils (Pearson's r: -0.677, P = 0.016). CONCLUSION: Postprandial leukocyte activation is accompanied by temporary changes in leukocyte cell population data, similar to changes observed during various infections, but to a lesser extent.
Assuntos
Leucócitos/metabolismo , Período Pós-Prandial , Adolescente , Adulto , Biomarcadores/metabolismo , Feminino , Citometria de Fluxo , Humanos , Imunofenotipagem , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Neutrófilos/metabolismo , Fatores de Tempo , Triglicerídeos/sangue , Adulto JovemRESUMO
Background. Recent data suggest that the renin-angiotensin system may be involved in triglyceride (TG) metabolism. We explored the effect of the common A1166C and C573T polymorphisms of the angiotensin II type 1 receptor (AT1R) gene on postprandial lipemia. Methods. Eighty-two subjects measured daytime capillary TG, and postprandial lipemia was estimated as incremental area under the TG curve. The C573T and A1166C polymorphisms of the AT1R gene were determined. Results. Postprandial lipemia was significantly higher in homozygous carriers of the 1166-C allele (9.39 ± 8.36 mM*h/L) compared to homozygous carriers of the 1166-A allele (2.02 ± 6.20 mM*h/L) (P < 0.05). Postprandial lipemia was similar for the different C573T polymorphisms. Conclusion. The 1166-C allele of the AT1R gene seems to be associated with increased postprandial lipemia. These data confirm the earlier described relationships between the renin-angiotensin axis and triglyceride metabolism.
Assuntos
Antipsicóticos/efeitos adversos , Síndrome Maligna Neuroléptica/diagnóstico , Síndrome Maligna Neuroléptica/etiologia , Risperidona/efeitos adversos , Adulto , Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Risperidona/uso terapêuticoRESUMO
In autoimmune hypothyroidism (Hashimoto's disease), TPO (thyroid peroxidase) antibodies may be detected, while in autoimmune hyperthyroidism (Graves' disease) thyroid-stimulating hormone (TSH ) receptor antibodies (TSH -R-AB s) are frequently present. Less well known is the fact that autoimmune hypothyroidism can present with TSH-R-ABs and ophthalmic Graves' disease (OGD). This condition is also known as hypothyroid Graves' disease. In this report we describe four patients with this uncommon phenomenon. These four cases demonstrate that differences between Hashimoto and Graves' disease are less clear than expected. Hypothetically the thyroid cell might be 'attacked' by blocking and stimulating antibodies. Dependent on the relative concentrations, hypothyroidism or hyperthyroidism may occur. So the differences between Hashimoto's disease and Graves' disease, at least in these cases, may be gradual and small.
Assuntos
Oftalmopatia de Graves/diagnóstico , Doença de Hashimoto/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Oftalmopatia de Graves/sangue , Doença de Hashimoto/sangue , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Nosocomial infections are a frequent concern in healthcare. Despite the available knowledge on nosocomial infections and preventive measures, outbreaks of infections continue to occur. An outbreak of severe sepsis in patients who underwent minor procedures in an operating theatre during two consecutive days is described and analysed in this study. We performed a retrospective cohort study using epidemiological data in order to investigate the source of infection together with microbiological and on-site investigations and interviews. Seven patients met the case definition of postoperative systemic inflammatory response syndrome (SIRS). All other patients operated on over the same period served as controls. Of the risk factors investigated, general anaesthesia and propofol were statistically significant (P=0.003). Klebsiella pneumoniae and Serratia marcescens were cultured from opened vials of propofol, propofol-related devices and from blood cultures from two of the patients. These strains were genotypically indistinguishable. Lapses in aseptic preparation, handling and storage of the propofol were observed, and were the most probable cause of the extrinsic contamination. The daily procedure of handling propofol was not performed according to the manufacturer's recommendations, the main departure being the use of a single-use vial for multiple patients. This study documents the risk of infection due to contaminated propofol and the importance of having written guidelines for its handling.
Assuntos
Anestésicos Intravenosos , Surtos de Doenças , Contaminação de Medicamentos , Klebsiella pneumoniae/isolamento & purificação , Propofol , Sepse , Serratia marcescens/isolamento & purificação , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Guias como Assunto , Humanos , Higiene , Entrevistas como Assunto , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/etiologia , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/microbiologia , Adulto JovemRESUMO
Lipoprotein transport is thought to occur in the plasma compartment of the blood, where lipoproteins are modulated by various enzymatic reactions. Subsequently, lipoproteins can migrate through the endothelial barrier to the subendothelial space or are taken up by the liver. The interaction between pro-atherogenic (apoB-containing) lipoproteins and blood cells (especially monocytes and macrophages) in the subendothelial space is well known. This lipoprotein-inflammatory cell interplay is central in the development of the atherosclerotic plaque. In this review, a novel interaction is described between lipoproteins and both leukocytes and erythrocytes in the blood compartment. This lipoprotein-blood cell interaction may also be related to the process of atherosclerosis by inducing inflammatory changes in the case of leukocytes (pro-atherogenic) and as an anti-atherogenic transport-system by adherence to erythrocytes. Triglyceride rich lipoprotein (TRL)-mediated leukocyte activation can lead to an inflammatory situation with generation of oxidative stress and the production of cytokines, ultimately resulting in acute endothelial dysfunction. Binding of apoB containing lipoproteins to erythrocytes may be a potential anti-atherogenic mechanism protecting the vessel wall from the pro-inflammatory effects of these lipoproteins and also playing a role in the removal of these particles from the circulation. One of the proposed mechanisms of this interaction implies complement activation on the lipoprotein surface and binding to the Complement Receptor 1 (CR1) on erythrocytes and leukocytes, followed by clearance by the liver.