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Biomedical subjects

R J Deckelbaum

Publications and source records attributed to R J Deckelbaum.

At least 145 records · Page 8Linked to original sources

Recurrent Reye-like syndrome: possible association with Krebs cycle abnormality.

During a 7-year period, a 15-year-old boy experienced recurrent attacks that clinically and pathologically resembled Reye's syndrome. The attacks were precipitated by prolonged exercise, fasting or infections. An extensive investigation failed to identify a toxic cause or specific metabolic disorder. Low 14CO2 production after in vitro incubation of the patient's liver with 14C-labeled palmitate, citrate and glutamine suggested a defect in the Krebs cycle or the oxidative phosphorylation pathway. This error may be responsible for the recurrent Reye-like syndrome attacks.

Adolescent↗

Primary hypertriglyceridemia in childhood.

Five of six children with severe familial primary hypertriglyceridemia in the first three to five years of life had what we believe is a new clinical feature, intermittent swelling of the limbs and scrotum. This was associated with higher levels of plasma triglyceride (greater than 2,000 mg/dL) and, in some instances, venous stasis of the affected part. All children had severe elevation of plasma chylomicron levels and mild elevation of very low-density lipoprotein levels. Four of the subjects were siblings who demonstrated heterogeneity in plasma lipase activities after heparin sodium administration. The clinical features and the lipase heterogeneities suggest that these patients possibly have an unusual variant of primary hypertriglyceridemia.

Child, Preschool↗

Relapsing pancreatitis in association with Crohn's disease.

Two adolescent girls, aged 15 and 18, in whom the diagnosis of Crohn's ileocolitis had been made 6 months and 3 years previously, developed acute pancreatitis with relapses of varying duration and severity. The younger patient's condition progressed to chronic relapsing pancreatitis with intractable pain despite partial pancreatectomy. The other has had recurrent acute attacks but has been well between bouts. No duodenal involvement could be found in the two cases and there was no evidence to implicate drugs as a factor responsible for this rare association between pancreatitis and Crohn's disease.

Acute Disease↗

Giardiasis in childhood: poor clinical and histological correlations.

Ten pediatric patients investigated for chronic diarrhea, chronic weight loss, or failure to thrive were found on intestinal biopsy and/or in a duodenal aspirate to have Giardia lamblia. Serum immunoglobulin levels were normal or elevated in all patients. Three children had increased excretion of fecal fat and three other children had low D-xylose absorption. Jejunal biopsy specimens showed two severe, three moderate, and two mild morphological abnormalities, and three were normal. Except for lactase deficiency, disaccharidase activities correlated poorly with the severity of mucosal damage on biopsy. Steatorrhea was seen only with the more normal biopsies. Immunofluorescent staining of the biopsies for IgG, IgM, IgA, and secretory piece revealed no immune defects. Thus, there was no single malabsorption defect associated with giardiasis, and the specific defects did not necessarily correlate with morphological changes.

Child↗

Continuous nasogastric drip elemental feeding. Alternative for prolonged parenteral nutrition in severe prolonged diarrhea.

Eighteen infants with severe prolonged diarrhea were fed successfully by continuous drip enteral feedings with an elemental diet. The mean weight gain was 6.4 +/- 0.7 g/kg/day, using a solution containing up to 87 kcal/dL at volumes up to 260 mL/kg/day. No cardiovascular or metabolic abnormalities occurred. Advantages of the continuous drip regimen were demonstrated by an adaptation phase with a plateau or even a decline in body weight in 12 patients, with weaning from continuous periodic feedings without changing the total caloric or volume intake. Continuous drip feeding provides an alternative for total parenteral nutrition in patients with severe prolonged diarrhea and intolerance to even an elemental diet given as periodic feedings.

Diarrhea↗

"Pseudoascites" as a presenting physical sign of celiac disease.

Two children initially referred for evaluation of ascites were diagnosed as suffering from celiac disease. Positive physical signs of ascites were present in the absence of free fluid in the peritioneal cavity. Physical findings of ascites were caused solely by dilated small intestinal loops filled with copious fluid. "Pseudoascites" should be recognized as a physical sign and possible mode of presentation of celiac disease.

Ascites↗

Strongyloidiasis in infancy. Case report and review.

A 15-month-old child with extreme failure to thrive due to intractable diarrhea since the age of 20 days was found to have live Strongyloides larvae in aspirated duodenal juice. Larvae were seen embedded in crypts of jejunal mucosa obtained by peroral biopsy. Following treatment with thiabendazole, a dramatic recovery ensued. The pathophysiology and clinical spectrum of strongyloidiasis is reviewed and the importance of its recognition stressed.

Biopsy↗

Cholesterol turnover and metabolism in two patients with abetalipoproteinemia.

Total body turnover of cholesterol was studied in two patients with abetalipoproteinemia, a 32-year-old man and a 31-year-old woman. The patients received [14C]cholesterol intravenously, and the resulting specific activity-time curves (for 40 and 30 weeks, respectively) were fitted with a three-pool model. Parameters were compared with those from studies of cholesterol turnover in 82 normal and hyperlipidemic subjects. A three-pool model gave the best fit for the abetalipoproteinemic patients, as well as for the 82 previously studied subjects, suggesting general applicability of this model. Cholesterol production rates in the two abetalipoproteinemic subjects (0.82 and 0.89 g/day) were close to values predicted for persons of their body weight. Thus, total body turnover rate of cholesterol was quite normal in abetalipoproteinemia, confirming previous reports. Very low values (9.2 and 8.4 g) were found for M1, the size of the rapidly exchanging compartment pool 1, in the two abetalipoproteinemic subjects. These values were well below the values predicted (from the comparison study population) for normal persons of this size with low plasma cholesterol levels. For one patient, total body exchangeable cholesterol was very low, although not significantly below the predicted values for a person of his size. In the second patient, the observed estimate for total body exchangeable cholesterol was well within the range of values predicted for persons of her size with low to extremely low cholesterol levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Abetalipoproteinemia↗

Thermal transitions and structural properties of synthetic cholesterol alkyl and alkenyl ethers: analogues of biological cholesterol esters.

Nine even-numbered saturated (C4 to C20) and two unsaturated (C18:1, C18:2) cholesterol alkyl ethers were studied by differential scanning calorimetry, polarizing microscopy, and X-ray powder diffraction. Seven of the nine saturated ethers examined melt into stable liquid crystal mesophases. Mesophase transition temperatures vary over a much narrower range than in cholesterol esters and are lower than those of corresponding esters. Polarizing microscopy and X-ray diffraction show structural similarities between cholesterol ethers and esters. Since cholesterol ethers behave similarly thermotropically to cholesterol esters, they may serve as suitable nonmetabolizable analogues for cholesterol esters in biological systems.

Calorimetry, Differential Scanning↗

Duplication of the gallbladder associated with childhood obstructive biliary disease and biliary cirrhosis.

A 4-yr-old girl presented with recurrent attacks of abdominal pain, vomiting, fever, and jaundice, progressing to biliary cirrhosis. The diagnosis of duplication of the gallbladder was established by transhepatic cholangiography. Clinical recovery and histologic improvement followed removal of the gallbladders. In every case of obstructive biliary disease or biliary cirrhosis in childhood, no effort should be spared in searching for a malformation of the biliary system.

Child, Preschool↗

Combined vitamin A and E therapy prevents retinal electrophysiological deterioration in abetalipoproteinaemia.

Eight patients with abetalipoproteinaemia had the typical ocular, systemic, and laboratory findings of this disease. Combined therapy with vitamins A and E was administered, starting as early as the first day of life and as late as 26 years of age. The patients were followed up for 2-6 years. Electroretinography was undertaken in all cases and electrooculography in some. After initiation of vitamin A and E therapy no progression of disturbed visual function could be detected in any patient. These objective tests of retinal function demonstrated that the combined vitamin A and E therapy may be useful in arresting retinal deterioration in abetalipoproteinaemia.

Abetalipoproteinemia↗

Role of apolipoprotein E-containing lipoproteins in abetalipoproteinemia.

Detailed studies of apolipoprotein E (apoE)-containing lipoproteins in abetalipoproteinemia have been performed in an attempt to resolve the apparent paradox of a suppressed low density lipoprotein (LDL) receptor pathway in the absence of apoB-containing lipoproteins. It was hypothesized that apoE-containing high density lipoproteins (HDL) in abetalipoproteinemia might functionally substitute for LDL in regulation of cholesterol metabolism in these patients. The mean (+/-standard deviation) plasma concentration of apoE in nine patients with abetalipoproteinemia was 44.8+/-8.2 mug/ml, slightly higher than the corresponding value for a group of 50 normal volunteers, 36.3+/-11 mug/ml. Fractionation of plasma lipoproteins by agarose column chromatography or by ultracentrifugation indicated that in abetalipoproteinemia, plasma apoE was restricted to a subfraction of HDL. This was in contrast to the results obtained with plasma from 30 normal volunteers, in whom apoE was distributed between very low density lipoproteins (VLDL) and HDL. Consequently, the mean apoE content of HDL in abetalipoproteinemia (44.8 mug/ml) was more than twice that found in the normal volunteers (20.3 mug/ml).ApoE-rich and apoE-poor subfractions of HDL(2) were isolated by heparin-agarose affinity chromatography. ApoE comprised a mean of 81% of the protein mass of the apoE-rich subfraction. Compared with the apoE-poor subfraction, the apoE-rich HDL(2) was of larger mean particle diameter (141+/-7 vs. 115+/-15 A) and had a higher ratio of total cholesterol/protein (1.01+/-0.11 vs. 0.63+/-0.14). Plasma and HDL fractions from three patients were studied with respect to their ability to compete with (125)I-LDL in specific binding to receptors on cultured human fibroblasts. The binding activity of plasma from patients (per milligram of protein) was about half that of plasma from normal volunteers. All binding activity in the patients' plasma was found to reside in the HDL fraction. The binding activity of the patients' HDL (on a total protein basis) was intermediate between that of normal HDL and normal LDL. However, the large differences in binding between patients' HDL and normal HDL entirely disappeared when data were expressed in terms of the apoE content of these lipoproteins. This suggested that the binding activity was restricted to that subfraction of HDL particles that contain apoE. These apoE-rich HDL particles had calculated binding potencies per milligram of protein 10-25 times that of normal LDL. Direct binding studies using (125)I-apoE-rich HDL(2) and (125)I-apoE-poor HDL(2), confirmed the suggestion that binding is restricted to the subfraction of HDL particles containing apoE. The apoE-rich HDL(2) were found to be very potent inhibitors of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase activity in cultured fibroblasts, providing direct evidence of the ability of these lipoproteins to regulate cholesterol metabolism. On the basis of binding potencies of apoE-rich HDL, apoE concentrations, and the composition of apoE-rich HDL, it could be calculated that apoE-rich HDL in abetalipoproteinemia have a capacity to deliver cholesterol to tissues via the LDL receptor pathway equivalent to an LDL concentration of 50-150 mg/dl of cholesterol. Thus, these apoE-rich lipoproteins are capable of producing the suppression of cholesterol synthesis and LDL receptor activity previously observed in abetalipoproteinemia.

Abetalipoproteinemia↗

Abnormal high density lipoproteins of abetalipoproteinemia: relevance to normal HDL metabolism.

We investigated high density lipoprotein (HDL) subfractions in abetalipoproteinemia (ABL) using rate zonal ultracentrifugation. In ABL, HDL2 is the major subfraction, 65% of total mass compared to less than 10% in normal subjects with similar HDL levels. HDL2 and HDL3 in ABL (n = 3) are larger and lighter than in normals (n = 3), with mean diameters of 136 +/- 19 A and 100 +/- 12 A, respectively (as compared to 113 +/- 12 A and 86 +/- 11 A), and contained more apoprotein E. ABL-HDL2 and HDL3 particles contain 2- to 2.5-fold more cholesteryl ester molecules than normals. ABL-HDL can be modified towards normal HDL by allowing VLDL triglycerides to exchange for ABL-HDL cholesteryl esters, followed by addition of lipoprotein lipase and hydrolysis of the triglycerides. In addition, ABL plasma contains a previously undescribed small and spherical (61 +/- 8 A) protein-rich (63% by weight) HDL fraction, which we call ABL-HDL4. Our data suggest that absence of cholesteryl ester transfer to triglyceride-rich lipoprotein in ABL causes accumulation of abnormally large cholesteryl ester-rich particles.

Abetalipoproteinemia↗

Importance of cholesterol-phospholipid interaction in determining dynamics of normal and abetalipoproteinemia red blood cell membrane.

Acanthocytic red blood cells in patients with abetalipoproteinemia have a decrease membrane fluidity that is associated with increased sphingomyelin/phosphatidylcholine (SM/PC) ratios. Here we describe studies designed to gain better insight into (i) the interrelationship between the composition of lipoprotein and red blood cell membrane in abetalipoproteinemia patients and normal controls; and (ii) how the differences in lipid composition of the red blood cell membrane affect its fluidity. The increased SM/PC ratio found in abetalipoproteinemia plasma high density lipoproteins (HDL) (3 times greater than controls) was paralleled by an increase in this ratio in acanthocytic red cells, but to a lesser degree (almost twice greater than control red cells). Cholesterol/phospholipid mole ratios (C/P) were increased 3-fold in abetalipoproteinemia HDL, but only slightly increased in red cells compared to controls values. As in the controls, 80-85% of abetalipoproteinemia red cell sphingomyelin was found to be in the outer half of the erythrocyte membrane. Membrane fluidity was defined in terms of microviscosity (eta) between 5 and 42 degrees C by the fluorescent polarization of 1,6-diphenylhexatriene (DPH) present in erythrocyte ghost membranes. At all temperatures, membrane microviscosity was higher in abetalipoproteinemia ghosts than controls, but these differences decreased at higher temperatures (12.34 vs 9.79 poise, respectively at 10 degrees C; 4.63 vs 4.04 poise at 37 degrees C). These differences were eliminated after oxidation of all membrane cholesterol to cholest-4-en-3-one by incubation with cholesterol oxidase. Following cholesterol oxidation, the membrane microviscosity decreased in patient ghosts more than in normal red blood cells so that at all temperatures no significant differences were present relative to control ghosts, in which the apparent microviscosity was also diminished but to a lesser degree. Therefore, although increased SM/PC ratios in abetalipoproteinemia may be responsible for decreased erythrocyte membrane fluidity, these effects are dependent upon normal interactions of cholesterol with red cell phospholipid.

Abetalipoproteinemia↗

Pneumoscrotum complicating percutaneous liver biopsy.

Pneumoscrotum developed after percutaneous liver biopsy in a 5-yr-old boy. Fifteen minutes after the procedure an enlargement of the right scrotum was noted. X-rays revealed a very small right-sided pneumothorax, subcutaneous air dissecting along the right chest and right abdominal walls and a confluent pocket of air in the right scrotum. We suggest that the air from the pleural cavity penetrated the superficial fascia in the upper right abdomen and dissected beneath the deep membranous layer into the scrotum.

Biopsy↗