M. Blazek

Urinary Neopterin and Microalbuminuria in Patients Treated by Low-density Lipoprotein Apheresis

Abstract Low-density lipoprotein (LDL)-apheresis is a method of extracorporeal elimination of LDL-cholesterol in patients with severe primary lipoprotein disorders. LDL-cholesterol activates macrophages, which play an important role in atheromatous plaque formation. In the present study, we have investigated urinary neopterin, a specific marker of macrophage activation and microalbuminuria, an indicator of generalized vascular dysfunction, after a single LDL-apheresis procedure in 10 patients with severe primary lipoprotein disorder. The urinary neopterin/creatinine ratio was increased in patients compared to controls. No significant changes of the neopterin/creatinine and albumin/creatinine ratios were observed after LDL-apheresis, except a significant (p < 0.006) decrease of urinary neopterin/creatinine ratio in the evening after the apheresis. This decrease showed significant negative correlation with the pre-apheretic levels of atherogenic cholesterol fractions (p < 0.05) and with cholesterol decrease during the apheresis (p < 0.05). Urinary albumin/creatinine ratio correlated positively with total and LDL-cholesterol levels before the apheresis and with the evening urinary neopterin/creatinine ratio after the apheresis, but did not correlate with glycemia and triacylglycerides. Elevated urinary neopterin in the patients with severe primary lipoprotein disorders reflects the presence of atherosclerosis. A single LDL-apheresis procedure did not significantly affect microalbuminuria. The decrease of urinary neopterin in the evening after the apheresis corresponds with the diurnal rhythm of neopterin excretion and was less pronounced in patients with more severe hypercholesterolemia. The correlations between microalbuminuria, neopterin and pre-apheretic cholesterol concentrations indicate a possible connection between microvascular dysfunction, macrophage activity and severity of hyperlipidemia, but these results should be interpreted with caution because of small number of subjects evaluated.

Quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation: The effect of selected psychosocial and health aspects on quality of life: A retrospective analysis

Summary Background Quality of life (QoL) is defined as “a patients subjective evaluation of his life situation”. QoL evaluation is carried out by means of generic and specific questionnaires. Generic QoL questionnaires generally evaluate a patients overall condition regardless of his disease. Specific QoL questionnaires are designed to evaluate a patients overall condition for a particular type of disease. Aim The study analyses the effect of selected psychosocial and health aspects on quality of life in patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation. Materials/Methods The total number of respondents undergoing transplantation between 2001 and 2003 was 56:32 respondents (18 male and 14 female) with multiple myeloma, and 24 respondents (11 male and 13 female) with malignant lymphoma. The average age of patients with multiple myeloma was 60 years and the average age of patients with malignant lymphoma was 44.5 years. The Czech version of the international generic European Quality of Life Questionnaire, Version EQ-5D, was used. The effect of selected psychosocial and health aspects (age, sex, level of education, marital status, number of associated diseases, smoking abuse, religion, type of disease and time since the transplantation) on quality of life in patients was determined by means of analysis of variance. Results The above-mentioned aspects proved statistically significant dependence of quality of life on age, smoking abuse in patients with multiple myeloma and on type of disease. EQ-5D score (dimensions of quality of life) and EQ-5D VAS (subjective health condition) significantly decrease with increasing age in both groups of patients and with smoking abuse in patients with multiple myeloma, and are significantly higher in patients with malignant lymphoma. The effect of other aspects on quality of life was not proven as statistically significant. The quality of life in patients with multiple myeloma undergoing autologous progenitor stem cell transplantation is at a lower level (mean EQ-5D score 68.9%, mean EQ-5D VAS 66.6%) than in patients with malignant lymphoma after the transplantation (mean EQ-5D score 82.7%, mean EQ-5D VAS 76.7%) at the Department of Clinical Haematology of the Department of Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. Conclusion The global quality of life in our patients with multiple myeloma and malignant lymphoma undergoing autologous progenitor stem cell transplantation is at a good level.

Extracorporeal LDL cholesterol elimination (25 years of experience in CZ)

In the Czech Republic the therapy of severe familial hypercholesterolemia (FH) by extracorporeal elimination using LDL-apheresis (immunoadsorption) and hemorheopheresis is concentrated into one center. The authors evaluate the long-term therapy (3-12 years, median 7,25) in 12 patients with FH - 3 homozygous, 9 heterozygous; Fredrickson type IIa, IIb (treated: 9 by LDL-apheresis and 3 by hemorheopheresis). Immunoapheretic interventions decrease LDL-cholesterol, ApoB and even Lp(a) by about 82 +/- 1; 73 +/- 13; 82 +/- 19 %, respectively. Selected non-invasive methods are important for a long-term and repeated follow-up. Carotid intima-media thickness showed improvement or stagnation in 75% of the patients. The level of some adhesive molecules, cytokines, endoglin and some coagulation functions were measured, but no universally accepted biomarkers informing of the actual activity of the disease were found to predict and plan the therapy. A program for procedure planning with the use of Microsoft® Excel for Windows® was developed. In summary, LDL-apheresis and hemorheopheresis substantially lower LDL-cholesterol in FH. Our experience with long-term therapy also shows good tolerance and a small number of complications (5,6% of clinically irrelevant side-effects). Hemorheopheresis may improve blood flow in microcirculation in familial hypercholesterolemia and also in some other disorders of microcirculation.

Re: Pyoderma gangrenosum: an uncommon cause of septic shock

had a leucocytosis, and an abdominal ultrasound showed no free fluid. He subsequently underwent abdominal computed tomography (CT) imaging, which showed no free fluid or free gas, with the solitary finding of a markedly thickened appendiceal wall (10 mm) with adjacent fat stranding (see Fig. 1), consistent with an inflamed appendix. He underwent a diagnostic laparoscopy, which confirmed the clinical and radiological suspicion of acute appendicitis, and an appendicectomy was performed. He had an uneventful postoperative course and was discharged the next day. Histological examination confirmed an acutely inflamed appendix, but without an intraluminal faecolith. Blunt abdominal trauma and appendicitis are two of the most common presentations requiring surgical consultation in Australian emergency departments. While the trauma setting is not immediately conducive to consideration of this differential, acute traumatic appendicitis has been described, with animal studies confirming this mechanism of action. Ramsook et al. (2001) provided criteria for diagnosing post-traumatic appendicitis to differentiate patients with undiagnosed appendicitis incurring incidental abdominal trauma: absence of abdominal pain prior to trauma, time interval between injury and symptoms of 6–48 h, and the development of progressive abdominal symptoms leading to appendicectomy, with positive pathological findings. These factors were all confirmed in the current case.