Nothing but the truth.
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Animal Testing Alternatives↗
Biomedical subjects
B Slavin
Publications and source records attributed to B Slavin.
Prolonged infection with hepatitis B virus and association between low blood cholesterol concentration and liver cancer.
OBJECTIVE: To determine whether prolonged infection with hepatitis B virus is associated with a lower blood cholesterol concentration. DESIGN: Cross sectional study. SETTING: 81 villages in rural China with a high prevalence of chronic infection with hepatitis B virus. SUBJECTS: 1556 apparently healthy men aged 35-64 years, randomly selected. MAIN OUTCOME MEASURES: Hepatitis B virus carrier state; plasma concentrations of cholesterol, apolipoprotein B, and apolipoprotein A I. RESULTS: 238 (15%) of the men were positive for hepatitis B surface antigen, indicating that they were chronic carriers. Plasma concentration of cholesterol was 4.2% (0.11 mmol/l) lower among carriers (that is, positive for hepatitis B surface antigen) than among non-carriers (95% confidence interval 0.6% to 8.0% (0.01 to 0.21 mmol/l), p < 0.05), and apolipoprotein B concentration was 7.0% (0.036 g/l) lower (2.8% to 11.2% (0.014 to 0.058 g/l), p < 0.001). In contrast, no association was observed between plasma concentrations of cholesterol or apolipoprotein and hepatitis B that had been eradicated (that is, patient positive for hepatitis B core antibody but negative for hepatitis B surface antigen). CONCLUSIONS: Chronic hepatitis B virus infection, which usually starts in early childhood in China, seems to lead not only to a greatly increased risk of death from liver disease but also to a somewhat lower cholesterol concentration in adulthood. This common cause produces an inverse association between cholesterol concentration and risk of death from liver cancer or from other chronic liver diseases.
Adult↗
One year experience in the treatment of familial hypercholesterolaemia with simvastatin.
Patients with heterozygous familial hypercholesterolaemia (FH) have a substantially increased risk of atherosclerosis due to very high plasma levels of cholesterol. Recent evidence has shown that coronary heart disease in these patients may regress with lipid-lowering therapy. In this study the efficacy and safety of simvastatin, an inhibitor of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A, was investigated in 30 patients with FH over a period of one year. Substantial reductions in the plasma concentrations of total cholesterol (-28%), low-density lipoprotein (LDL) cholesterol (-32%), intermediate-density lipoprotein (IDL) cholesterol and apolipoprotein (apo) B (-33%) were achieved with 20 mg/day of simvastatin; there were no significant changes in triglycerides high-density lipoprotein cholesterol or apo A. In contrast to previous studies, 40 mg/day of simvastatin did not result in a further statistically significant fall in LDL cholesterol, IDL cholesterol or apo B in the group as a whole. The drug was well tolerated and no adverse clinical or laboratory events were recorded. In particular, no ophthalmological, hepatic or renal disorders were observed and there were no sleep disturbances. We conclude that simvastatin is an efficacious and safe drug to treat patients with heterozygous FH and that rarely will the dose need to be increased above 20 mg/day.
Adult↗
Blood mononuclear cells from patients with psoriasis exhibit an enhanced adherence to cultured vascular endothelium.
Blood mononuclear cells (MNC) from patients with psoriasis were more adherent to monolayers of endothelial cells prepared from human umbilical cord vein than otherwise similar cells from control subjects. This increase in adherence occurred in the presence (mean 37% increase; p less than 0.01) and absence (mean 47% increase; p less than 0.05) of 10% autologous serum and was not related to the disease severity of the patients. The augmented adhesiveness of the patients' cells was also apparent when using monolayers of endothelial cells isolated from human skin. The levels of immune complexes, complement, alpha 2-macroglobulin, acute phase proteins (alpha 1-acid glycoprotein, C-reactive protein and alpha 1-antitrypsin), and tumor necrosis factor alpha (TNF alpha), interleukin-1 alpha (IL-1 alpha), and interleukin-1 beta (IL-1 beta) in the patients' sera were within normal limits. When MNC were added to endothelial monolayers that had been incubated with either TNF alpha or the highest concentration of rIL-1 beta used in the study, both the patients' and control's cells exhibited a similar increase in attachment (p less than 0.01). Pretreatment of endothelium with interferon-gamma did not enhance the attachment of MNC from either group of subjects. The augmented adherence of the patient's MNC appears to be due to an abnormal adhesiveness of the lymphocytes rather than the monocytes and is not related to an enhanced expression of the cell-surface adhesion molecules CD11a/CD18. It is likely that the circulating MNC of psoriatic patients may be predisposed for extravasation into skin.
Cell Adhesion↗
Rural/urban differences of diabetes--impaired glucose tolerance, hypertension, obesity, glycosolated haemoglobin, nutritional proteins, fasting cholesterol and apolipoproteins in Fijian Melanesians over 40.
Two populations of Fijian Melanesians over 40 years of age were compared. The first population was located in a remote rural area and the other in an urban environment. There was no significant difference between the two populations in age, height and diastolic blood pressure. Highly significant differences were observed in mean weight, body mass index, prevalence of impaired glucose tolerance, prevalence of diabetes, mean glycosolated haemoglobin, mean systolic blood pressure, fasting cholesterol, immunological albumin, immunological transferrin, and A1 and B apolipoproteins. The higher value was associated with urban living. Thus urban living is associated with obesity, impaired glucose tolerance, diabetes, higher systolic blood pressure, higher levels of fasting lipids and increased risk factors for cardiovascular disease.
Apolipoprotein A-I↗
Clinical validation of St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol).
Recently, the St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol) has become available commercially in the UK. In a series of patients (n = 28) undergoing open heart surgery for a variety of lesions, a clinical validation was performed. Preservation of myocardial contractility was assessed biophysically by quantitative birefringence measurements of myocardial biopsy samples (full thickness apical left ventricle and right ventricle) taken (1) prior to ischaemia, (2) at the end of ischaemia and (3) 10-15 min after reperfusion during cardiopulmonary bypass. In addition, serum CK-MB values were measured in samples taken throughout the operation and for 4 days postoperatively. Postoperative ECG traces (taken every 6 h for 48 h and then daily up to 7 days) were analysed to identify the occurrence of perioperative infarction. There were no hospital deaths. Chronotropic support was required in 5 of 28 patients (18%) for transient heart block. Low cardiac output did not occur postoperatively. Birefringence measurements in biopsy samples taken at the end of the ischaemic period (immediately prior to reperfusion) indicated an apparent left ventricular deterioration in myocardial contractility in 12 of 28 patients (43%) when compared to biopsies sampled prior to the ischaemic period. However, after 10-15 min of aerobic reperfusion, measurements indicated that myocardial contractility recovered to almost pre-ischaemic levels in the majority of patients. Thus, in 22 of 28 patients (79%), left ventricular deterioration did not occur in post-ischaemic biopsy samples when compared to the pre-ischaemic biopsies. Similarly, 21 of 28 patients (75%) had no deterioration of birefringence values in right ventricular biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)
Bicarbonates↗
Small-intestinal function during enteral feeding and starvation in man.
1. Small-intestinal absorption and permeability were measured in nine patients with malnutrition who were receiving liquid enteral nutrition after different periods of starvation, in five patients receiving enteral nutrition without starvation, in six healthy subjects after starvation for 36 h and in two obese subjects starved for 11 days. 2. Absorption, expressed by the plasma 60 min D-xylose level and the plasma 60 min D-xylose/3-O-methyl-D-glucose ratio, was greatly decreased (P less than 0.001) in the nine patients receiving enteral feeding after starvation, whereas permeability, denoted by the 5 h urinary lactulose/rhamnose ratio, was increased (P less than 0.05). 3. The five patients receiving enteral feeds without prior starvation had normal intestinal absorption and permeability. 4. Starvation of the healthy subjects reduced absorption (P less than 0.05) and this was detectable at 36 h. Permeability, however, was not increased by 36 h starvation. Starvation of the obese subjects also progressively reduced absorption, and this was reversed with refeeding. 5. Changes in intestinal function during enteral feeding are similar to those seen in intestinal diseases. They develop rapidly and are not caused or reversed by liquid enteral feeds. Starvation, before beginning feeding, may explain some of the changes found.
Adult↗
Alpha 1-antitrypsin phenotypes in acute anterior uveitis.
The alpha 1-antitrypsin phenotype PiMZ has been reported to have a higher than normal incidence in patients with acute anterior uveitis, indicating an important role in the immunogenetics of this condition. We have determined the incidence of this phenotype in 72 patients with acute anterior uveitis. It was found to occur in four patients (5.6% of the total), with the highest incidence (3/34 or 8.8%, p less than 0.001) in patients negative for HLA B27 and without sacroiliac joint disease. The incidence in HLA B27 positive patients was normal. No correlation was found with the severity, bilaterality, or recurrence of uveitis. Although this increased incidence is statistically significant in comparison with the normal population incidence of 2.6%, its direct clinical significance is questionable; the most likely explanation for it includes possible linkage with other immunoregulatory genes. We also found a lower than expected incidence of the phenotype PiMS, and discuss the relevance of this finding.
Adolescent↗
Acquired common variable hypogammaglobulinaemia and lymphoedema.
Two patients with lymphoedema of the legs developed recurrent respiratory infections and were found to have panhypogammaglobulinaemia. The early recognition and treatment of this form of immunity deficiency in patients with lymphoedema is important in order to prevent recurrent infections which could cause pulmonary damage and further lymphatic stasis.
Adult↗
Chronic splenomegaly in Nairobi, Kenya. I. Epidemiology, malarial antibody and immunoglobulin levels.
Chronic splenomegaly in 131 Kenyan patients was investigated at Kenyatta National Hospital, Nairobi. Patients were allocated to diagnostic groups on the basis of clinical, haematological, parasitological, histological, radiological and endoscopic data. The major diagnostic groups were hyper-reactive malarial splenomegaly, our preferred name for tropical splenomegaly syndrome, (31%), hepatosplenic schistosomiasis (18%), visceral leishmaniasis (5%) and "indeterminate splenomegaly", where no diagnosis could be reached (12%). Another 20% of patients were suffering from various non-schistosomal forms of portal hypertension. A number of specific and rarer causes accounted for the rest of the cases. The tribal and geographical distribution of patients with chronic splenomegaly was compared with the pattern of general medical admissions. Splenomegaly was more frequent than expected in Kamba and Luo patients. Hyper-reactive malarial splenomegaly and hepatosplenic schistosomiasis were common in both groups, whereas visceral leishmaniasis was almost restricted to the Kamba and indeterminate splenomegaly was especially prevalent in the Luo. Malarial antibody and immunoglobulin levels differed significantly between the various diagnostic categories of patients and controls. Malarial serology can be diagnostically useful for chronic splenomegaly, provided results are interpreted in their geographical context.
Antibodies, Protozoan↗
Chronic splenomegaly in Nairobi, Kenya. II. Portal hypertension.
Eighty-five patients with chronic splenomegaly and proven oesophageal varices were studied at Kenyatta National Hospital, Nairobi. The major defined groups were hepatosplenic schistosomiasis (24%), cirrhosis (20%) and portal vein occlusion (11%). Hyper-reactive malarial splenomegaly (tropical splenomegaly syndrome) was considered as the cause of oesophageal varices in only one patient. In 26% of cases liver biopsy was non-diagnostic and the extrahepatic portal vein was demonstrated radiologically to be patent. Such patients were thought to be suffering from idiopathic portal hypertension, not previously described elsewhere in Africa. Hepatitis B surface antigen was detected in 12% of controls and in 58% of patients with cirrhosis (p less than 0.001). Some serological marker of previous hepatitis B virus infection was present in 92% of patients with cirrhosis and in 79% of controls. Kamba patients from Machakos and Kitui Districts were significantly more prevalent than expected among these 85 cases of portal hypertension.
Esophageal and Gastric Varices↗
Prophylactic effect of aminophylline and salbutamol on histamine-induced bronchoconstriction.
The effect of salbutamol 200 micrograms aerosol, i.v. high-dose aminophylline 670 mg or placebo (aerosol and infusion) on bronchomotor tone were compared in normal volunteers before and after bronchial provocation with histamine aerosol 500 micrograms. The study was a double-blind cross-over design. Specific airways conductance of the lower airway (s. Glaw) was measured using a forced airflow oscillation technique. All subjects receiving aminophylline had tremor and irritability, whereas after salbutamol there were no noticeable systemic or psychological effects. Before the administration of histamine, salbutamol caused significant bronchodilatation compared with control: aminophylline did not induce a significant change in airway conductance. The effect of histamine administration on s. Glaw was only partially blocked by the high dose of aminophylline, but was completely blocked by salbutamol.
Albuterol↗
Maternal nutrition and intrauterine growth retardation.
Nutritional factors associated with intrauterine growth retardation (IUGR) were studied in 118 mothers, from an inner London population, 24-48 h after delivery. Lower socio-economic status, smoking and, in the diet, only a low dietary intake of zinc were significantly associated with IUGR. It is suggested that women at risk of delivering babies small-for-gestational-age might benefit from an increased zinc intake.
Adult↗
Immunoglobin M and malarial antibody levels in hyper-reactive malarial splenomegaly.
In a study of chronic splenomegaly in Kenya, hyper-reactive malarial splenomegaly, our preferred name for tropical splenomegaly syndrome, was diagnosed in 38 patients. This diagnosis was based on exclusion of other conditions and observations of hepatic sinusoidal lymphocytosis on liver biopsy. To assess the previously recommended diagnostic criterion of elevation of serum IgM, to two standard deviations (s.d.) above the local mean, serum IgM levels were measured in patients and in 90 geographically matched controls. Patients with IgM levels 2 s.d. above the local mean were compared with those with lower levels. No differences were found other than higher malarial antibody titres in the group with higher IgM levels. Agreement is required concerning diagnostic criteria for hyper-reactive malarial splenomegaly; other features of the syndrome may occur in the absence of marked IgM elevation.
Adult↗
Hyperamylasemia after ERCP with ionic and non-ionic contrast media.
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Acute Disease↗
Comparison of immunoglobulin and malaria antibody values in rural Kenyans.
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Adult↗
False diagnosis of phaeochromocytoma in patients on Sinemet.
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Adrenal Gland Neoplasms↗
Hormonal and electrolyte responses during and after open heart surgery.
Maintenance of the balance of electrolytes and hormones within their normal range is necessary for normal myocardial metabolism. Open heart surgery involving cardiopulmonary bypass produces metabolic disturbances which affect normal metabolic homeostasis. Several studies have suggested that pulsatile cardiopulmonary bypass causes less severe metabolic disturbance than non-pulsatile bypass and that non-pulsatile bypass causes hypofunction of the anterior pituitary and adrenal glands. The present study, however, with non-pulsatile flow showed that there was no evidence of hypothalamo-pituitary-adrenal axis hypofunction when the hormonal values of corticotrophin (ACTH), cortisol and cortisone were corrected for the hemodilution involved in cardiac surgery. Electrolytes, particularly calcium, play an important role in myocardial contractility. The levels of ionized calcium are normally controlled by parathyroid hormone (PTH) with a negative feedback of calcium controlling the system. However, this study showed that significant increases in bioactive PTH during cardiopulmonary bypass were not related to the calcium concentration, but appeared to be influenced by low blood pH values and by the degree of hypothermia.
Adrenocorticotropic Hormone↗