Changes in serum lipids and lipoproteins in epileptic children treated with anticonvulsants

Laparoscopic cholecystectomy is a popular treatment modality of symptomatic gallstones with decreased major complications and shortened hospital stay. Complications following laparoscopic cholecystectomy, most of them involving strictures of biliary tract have been well described in recent reports. However, there are only a few reported cases about dropped gallstones after the procedure, all of which were opaque and easily demonstrated with multiple imaging modalities. An unusual complication of laparoscopic cholecystectomy; abscess formation due to a dropped non-opaque gallstone is described in which diagnosis was suggested with the combination of ultrasound and computed tomography findings and confirmed by surgery.     

Serum intact parathyroid hormone and ionised calcium concentration in children with renal insufficiency

We report our experience of the use of an immunoradiometric assay for intact parathyroid hormone (i-PTH) and the measurement of plasma ionised calcium concentration (PCa2+) in 73 children with chronic renal insufficiency (CRI); plasma creatinine concentration (PCr) 52-856 mumol/l. There was a poor correlation between i-PTH and PCr (r = 0.10, n = 552) compared with that for C-terminal PTH and PCr (r = 0.60, n = 248), suggesting that the i-PTH assay is independent of renal function in this group of treated children. A clear response of i-PTH to a low total plasma Ca (tPCa) and PCa2+ was observed. There was a significant positive correlation between both tPCa and PCa2+ (r = 0.50, n = 389) and the fraction of Ca2+ (the fraction of tCa which was ionised) and PCa2+ (r = 0.50, n = 389). The finding of a low or normal PCa2+ with a low calculated fraction of Ca2+ was frequently observed, i.e. the measured tPCa was unexpectedly high, suggesting complexing of Ca2+ by accumulated anions in CRI. There was a poor relationship between the plasma albumin concentration and both bound plus complexed Ca (tPCa minus PCa2+) and the fraction of Ca2+ (r = 0.15 and -0.17, respectively). The positive predictive value for a raised i-PTH of a tubular reabsorption of phosphate of less than 80% was 0.87, and of an alkaline phosphatase greater than 800 U/l was 0.37.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immunoglobulin abnormalities in epileptic patients treated with diphenylhydantoin

An immunologic study was made on 170 epileptic patients treated with antiepileptic drugs. The most noteworthy finding was that the serum IgA was decreased in 22 patients, and an IgA deficiency noticed in 12 of them. The blastic transformation rate of lymphocytes in PHA-containing cultures appeared low in seven out of 12 patients. Other findings included decreased serum IgM and IgG in some patients. These abnormalities were not encountered in epileptic patients taking no anti-epileptic drugs. Therefore, they could be considered as the side effects of antiepileptic drugs. In all patients manifesting these abnormalities, diphenylhydantoin was used in common. It was surmised that the above-mentioned immunologic abnormalities caused by anti-epileptic drugs, especially diphenylhydantoin, had resulted from disorders of the antibody producing organs in the bone marrow-thymus-lymphatic system.     

Course of blood levels of calcium, inorganic phosphate, alkaline phosphatase, parathyroid hormone and calcidiol (25-OH-D3) in one and two year old thoroughbred horses

The present study was aimed to determine the contents of calcium, inorganic phosphate, parathormon, 25-OH-D3 and the activity of alkaline phosphatase in the plasma of one- and two-years-old thoroughbred horses. Data were obtained monthly from 44 one-year-old thoroughbred of 4 different studs from May during grazing-season and from October during stable-, resp. training-season up to april of the following year. Calcium, inorganic phosphate and the activity of alkaline phosphatase were measured with a photometric method and the concentration of PTH and 25-OH-D3 were determined with a radioimmunoassay. The following results were obtained: Calcium: The concentration of calcium in the plasma of one-year-old thoroughbred horses was 3.03 +/- 0.23 mmol/l during grazing-season and 3.14 +/- 0.14 mmol/l during the following stable-, resp. training-season. Inorganic phosphate: The concentration of inorganic phosphate was significantly affected by the age. The average was 1.7 +/- 0.19 mmol/l during grazing-season and 1.3 +/- 0.19 mmol/l during the following stable- and training-season. Activity of alkaline phosphatase: The activity of alkaline phosphatase was also significantly affected by the age. The average of the activity was 403 +/- 86 U/l during grazing-season and 308 +/- 65 U/l during the following winter period. Parathormon: There were big differences between the averages of parathormon during grazing-season (1.27 +/- 0.45 ng/ml) and the following winter-season (0.9 +/- 39 ng/ml). Besides from that there were big individual differences. 25-OH-D3: The concentration of 25-OH-D3 during grazing-season (10.38 +/- 3.08 ng/ml) was lower than during the winter period (13.03 +/- 2.86 ng/ml). The significance of the obtained results is discussed in relation to the corresponding literature.     

Serum lipid levels in children and teenagers from Concepción, Chile

BACKGROUND: There is a relationship between serum lipid levels in children with those of adults. Preventive measures to reduce serum lipid levels should start in childhood. AIM: To study serum lipid levels in a representative sample of children and teenagers from Concepción, Chile. SUBJECTS AND METHODS: Serum total, HDL cholesterol and triglycerides were measured in 1,286 males and 816 females from 5 to 18 years old in the city of Concepción. RESULTS: Mean total cholesterol levels were 159 +/- 30 and 162 +/- 31 mg/dl in males and females respectively. The figures for HDL cholesterol were 46 +/- 11 and 47 +/- 11 mg/dl, for LDL cholesterol were 94 +/- 27 and 96 +/- 29 mg/dl and for triglycerides were 80 +/- 35 and 87 +/- 38 mg/dl. Nine percent of males and 12% of females had a total cholesterol over 200 mg/dl. Likewise 10% of males and 11% of females had a LDL cholesterol over 130 mg/dl. CONCLUSIONS: These numbers will help to plan and perform interventions in children, in order to prevent cardiovascular diseases.     

Serum calcium, magnesium and inorganic phosphorous levels during various phases of menstrual cycle

BACKGROUND/AIM: Hepatic tumors with elements of both hepatocellular and cholangiocellular carcinoma are occasionally encountered; however, the independent and simultaneous occurrence of different epithelial malignant tumors in different lobes is rare. This is a case report of resected double cancer in different lobes of the liver. MATERIALS AND METHODS: A 73 year old Japanese man, with hepatic mass and a history of peritonitis and hepatitis, underwent laparotomy and hepatic resection of the posterior inferior and the left lateral segment, and cholecystectomy for cholecystlithiasis with left-sided gallbladder at our hospital in 1991. RESULTS: The tumor, located in the posterior inferior segment, a yellow-white, round, highly circumscribed mass with a thick capsule, was about 9.0 by 8.0 cm in size. The other tumor located in the left lateral segment, grayish-white on the cut section, was approximately 5.0 by 4.0 cm. CONCLUSION: In our case, it is unlikely the tumor in the right lobe metastasized to the left lobe and transformed into a different type. The two tumors showed clearly different microscopic features. Improved imaging will increase the frequency and number of double cancer diagnosis. This additional data may shed light on the pathogenesis and etiology of double cancer.     

Plasma levels of diphenylhydantoin (DPH) and phenobarbitone (PB) in epileptic patients resistant to drug treatment (author's transl)

The Authors present and discuss the results obtained by assaying plasma DPH and PB in 123 patients chronically treated with antiepileptic drugs. The subjects examined were considered resistant to medical therapy and were all at their first laboratory control. The data obtained show: 1) the very poor correlation existing between the doses of drugs administered and their actual plasma levels; 2) the very high percentage of patients with DPH and PB plasma levels not in the therapeutic range of these drugs. The Authors discuss some of the most frequent errors in planning chronic therapy with DPH and barbiturates due to the lack of knowledge of drug blood levels.     

Effect of varying alloxan concentration on serum levels of glucose, calcium and alkaline phosphatase in the rat

Two groups of rats were injected intravenously 20 and 40 mg alloxan/kg of body weight respectively. It was shown that different doses of alloxan induced the increase of glucose concentration, activity of alkaline phosphatase and decrease of calcium level in the rat serum. The above changes more expressed in the groups of rats that received the higher dose of alloxan.     

Prevalence, classification, and severity of epilepsy and epileptic syndromes in children

PURPOSE: To determine the point prevalence of active childhood epilepsy in a defined area and evaluate the usefulness of ILAE classification of seizures, and epilepsies/syndromes with special interest in severe epilepsies. METHODS: By using the latest ILAE International Classification of Epileptic Seizures (ICES, 1981) and Epilepsies and Epileptic Syndromes (ICE, 1989), we determined the age- and sex-specific prevalence rates of epilepsy, type of seizures, epilepsies, and recognizable epileptic syndromes, as well as the proportion of severe cases in each seizure/epilepsy/syndrome category in all children 0-15 years of age from a geographically defined area in Finland. All medical records, neurophysiological recordings and available clinical data were reviewed retrospectively. RESULTS: Point prevalence of active epilepsy on December 12, 1992 was 3.94 per 1,000. According to ICES/ICE, we were able to classify 96% of seizures and 90% of epilepsies and syndromes. Generalized seizure and epilepsy/syndrome types were more prevalent in children 0-6 years of age and partial/localization-related in children 6-15 years of age. Epilepsy was intractable in 17% of all cases and correlated significantly with symptomatic etiology and early onset of epilepsy, as well as with additional neuroimpairments. CONCLUSIONS: A considerable number of cases fell into the nonspecific categories of ICE, which limits the value of present epilepsy/syndrome classification in terms of prognosis, prediction, and indication for special investigations in individual cases. A number of intractable cases was relatively low, indicating good prognosis in many childhood epilepsies, especially when additional neuroimpairments are absent.     

Lithium effects on magnesium, calcium, and phosphate metabolism in rats

Rats were treated with lithium chloride for 8 weeks. At the last day of lithium administration, the animals were given radioactive calcium, magnesium, and phosphate. Electrolyte content and radioactivity were determined in serum, bone, muscle, liver and brain. Lithium led to an increase of inorganic phosphate in muscle and a decrease in serum. Uptake of radioactive phosphate was increased in muscle and liver but reduced in bone. The amount of magnesium in muscle and serum was increased in the lithium-treated rats, whereas the uptake of radioactive magnesium into bone was decreased. Uptake of radioactive calcium into bone was reduced, and radioactive calcium in serum was increased after lithium.     

Annual changes in serum calcium and inorganic phosphate levels and correlation with gonadal status of a freshwater murrel, Channa punctatus (Bloch)

Adult Channa punctatus murrels of both sexes (60-80 g) were collected locally from Ramgarh Lake during the second week of every month (10 individuals of each sex/month) throughout the year. Blood samples were collected and analyzed for serum calcium and phosphate levels by the methods of Trinder (1960) and Fiske and Subbarow (1925), respectively. Gonads were fixed to judge the state of maturation of the fish. Males exhibited no change in serum calcium levels throughout the year in correlation with testicular maturation. However, serum phosphate levels exhibited a rise in correlation with the increased gonadosomatic index. Females showed marked seasonal changes in serum calcium and phosphate levels which were associated with ovarian maturation (vitellogenesis).     

Variation of salivary calcium, phosphate and buffering capacity in adolescents

Calcium, phosphate and buffering capacity were measured in children's (n=43) unstimulated saliva between September 1990 and June 1991 inclusive. Saliva samples were collected in the afternoon, once a month, on 10 consecutive occasions. Buffering capacity was assessed immediately after sample collection using the Dentobuff strip method. The remainder of the saliva sample was then stored at -18 degrees C and, after thawing, total calcium and inorganic phosphate were measured. The intra-individual variation of buffering capacity over time was statistically significant (Friedman two-way ANOVA, p < 0.001). The intra-individual variability of salivary calcium was also statistically significant (repeated-measures ANOVA, p < 0.001). However, no evidence of a statistically significant variation in phosphate was observed. It is concluded that a combination of flow-rate fluctuation over time and the methods used to assess salivary constituents might have contributed to this variability.     

Serum 5-nucleotidase and alkaline phosphatase in patients with malignant neoplasms]

The biosynthetic abilities of WI-38 fibroblasts from early and late population-doubling-level cultures were compared by autoradiography of cells grown with labeled precursors of DNA, RNA, protein and lipids. Incorporation of radioactive thymidine, uridine, protein-hydrolysate, acetate, oleic acid and cholesterol, as measured by the number of grains per cell surface, decreased with the progressive aging of the culture. However, the decrease in the incorporation of acetate, oleic acid and cholesterol was much smaller than that of the other precursors, indicating that lipid synthesis is affected to a lesser degree than protein and nucleic acid synthesis on aging. This result is in accord with the higher lipid content and proliferation of intracellular membranes in cells of "old" WI-38 cultures reported by others.     

Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis

We compared the efficacy and the long-term effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) in controlling serum phosphate levels in patients with end-stage renal disease (ESRD). Patients underwent thrice weekly CHD and were subsequently switched to NHD six nights weekly. In the "acute" study serum and dialysate phosphate were measured during and after dialysis, and the total dialysate was collected to calculate mass solute removal. Although pre-dialysis (1.7 +/- 0.6 vs. 1.5 +/- 0.8 mM) serum phosphate levels were similar in CHD and NHD, respectively, post-dialysis levels were slightly lower with CHD (0.7 +/- 0.2 vs. 0.8 +/- 0.2 mM, P < 0.05). The measured phosphate removed per session of CHD or NHD was comparable, 25.3 +/- 7.5 versus 26.9 +/- 9.8 mumol/session, respectively. On the other hand, the cumulative weekly phosphate removal was significantly higher with NHD as compared to CHD, 75.8 +/- 22.5 versus 161.6 +/- 59.0 mumol/week (P < 0.01). In the "chronic" study serum phosphate levels were measured monthly for five months on CHD and for five months after the patients were switched to NHD. Dietary phosphate intake and the dosage of phosphate binders were tabulated. Serum phosphate levels fell during NHD: 2.1 +/- 0.5 mM at the beginning of the study and 1.3 +/- 0.2 mM five months after being switched to NHD (P < 0.001). At the same time dietary phosphate intake increased by 50%. By the fourth month of NHD therapy none of the patients was taking any phosphate binders. In conclusion, NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.     

Nomograms for the estimation of the saturation of urine with calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid, sodium acid urate, ammonium acid urate and cystine

The effects on respiratory frequency of preoptic heating during slow-and fast-wave sleep were studied in freely moving cats. During slow-wave sleep, at neutral ambient temperature, the subliminal range of preoptic temperature for thermal polypnea extends to 0.2-0.4 degrees C above control preoptic temperature. During fast-wave sleep, at neutral ambient temperature, the subliminal range of preoptic temperature for thermal polypnea increases beyond 0.9-1.0 degrees C above control preoptic temperature. Moreover, the polypneic response is weak and unstable. The results show the suspension of a precise thermoregulatory control during fast-wave sleep in a homoiothermic species.     

Serum leptin levels in women with anorexia nervosa

Leptin is a protein encoded by the ob gene that is expressed in adipocytes and regulates eating behavior via central neuroendocrine mechanisms. Serum leptin levels have been shown to correlate with weight and percent body fat in normal and obese individuals; however, it is not known whether the regulation of leptin is normal below a critical threshold of body fat in chronic undernutrition. We investigated serum leptin levels in 22 women, aged 23 +/- 4 yr, with anorexia nervosa. Duration of disease, weight, BMI, percent body fat, and serum leptin levels were determined for each patient. Nutritional status was assessed further by caloric intake and measurement of insulin and insulin-like growth factor I (IGF-I) levels. Twenty-three healthy women, aged 23 +/- 4 yr, taking no medications, with normal menstrual function and body mass index (BMI) between 20-26 kg/m2 (mean, 23.7 +/- 1.7 kg/m2), served as a control population for comparison of leptin levels. Subjects with anorexia nervosa were low weight (BMI, 16.3 +/- 1.6 kg/m2; normal, 20-26 kg/m2) and exhibited a striking reduction in percent body fat (7 +/- 2%; normal, 20-30%). The mean serum leptin level was significantly decreased in subjects with anorexia nervosa compared with that in age- and sex-matched controls of normal body weight (5.6 +/- 3.7 vs. 19.1 +/- 8.1 ng/mL; P < 0.0001). Serum leptin levels were correlated highly with weight, as expressed either BMI (r = 0.66; P = 0.002) or percent ideal body weight (r = 0.68; P = 0.0005), body fat (r = 0.70; P = 0.0003), and IGF-I (r = 0.64; P = 0.001), but not with caloric intake or serum levels of estradiol or insulin in subjects with anorexia nervosa. The correlation between leptin and body fat was linear, with progressively lower, but detectable, leptin levels measured even in patients with less than 5% body fat, but was not significant when the effects of weight were taken into account. In contrast, the correlation between leptin and IGF-I remained significant when the effects of weight, body fat, and caloric intake were taken into account. In normal controls, leptin correlated with BMI (r = 0.55; P = 0.007) and IGF-I (r = 0.44; P < 0.05), but not with fat mass. These data demonstrate that serum leptin levels are reduced in association with low weight and percent body fat in subjects with anorexia nervosa compared to normal controls. Leptin levels correlate highly with weight, percent body fat, and IGF-I in subjects with anorexia nervosa, suggesting that the physiological regulation of leptin is maintained in relation to nutritional status even at an extreme of low weight and body fat.     

Serum thrombopoietin levels in patients with aplastic anaemia

Endogenous serum thrombopoietin (TPO) levels were measured in 31 patients with aplastic anaemia (AA) using an enzyme immunoassay with a sensitivity of 20 pg/ ml. The median platelet count for all AA patients was 30 +/- 29 x 10(9)/l (range 5-102) compared with a median of 284 +/- 59 x 10(9)/l (range 148-538) for normal controls. Serum TPO levels were significantly elevated in all patients compared with normals (1706 +/- 1114.2, range 375-5000 v 78 +/- 54, range 16.5-312.9, P < 0.0001). There was no correlation between serum TPO levels and the degree of thrombocytopenia in AA patients, but TPO levels were significantly higher in patients who were platelet transfusion dependent than in patients who were transfusion independent (P < 0.01). There was a trend for higher TPO levels in patients with severe AA compared with non-severe AA patients. Clinical trials of TPO and a related truncated, pegylated molecule, megakaryocyte growth and development factor (PEG-rHuMGDF), are awaited to determine whether treatment with these drugs will result in increased platelet counts in patients with AA.