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We describe a case of Pseudallescheria boydii endocarditis involving the pulmonic valve in an orthotopic liver transplant recipient. The patient required transplantation because of hepatic failure secondary to chronic active hepatitis B. His postoperative course was complicated by surgery for gastric and duodenal ulcers, persistent fever, and, ultimately, sepsis leading to oliguric renal failure. Two days before death, the patient experienced complete heart block, and an echocardiogram revealed pulmonic valve thickening and an endocardial mass along the left side of the septum. At autopsy the patient was found to have a vegetation on the pulmonic valve and a septal abscess. There were multiple fungal emboli found throughout other organs, and P. boydii was obtained on culture. This unique association between pulmonic valve endocarditis and myocardial septal abscess is discussed. In addition, review of the five previous cases of P. boydii endocarditis reveals that this rare infection is associated with immunosuppression and prosthetic devices. [ABSTRACT FROM PUBLISHER]

General medicine general surgery, Médecine et chirurgie générales, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Maladies metaboliques, Metabolic diseases, Dyslipémies. Hyperlipoprotéinémies, Disorders of blood lipids. Hyperlipoproteinemia, Endocrinopathie, Endocrinopathy, Endocrinopatía, Appareil circulatoire pathologie, Cardiovascular disease, Aparato circulatorio patología, Diabète, Diabetes mellitus, Diabetes, Diagnostic, Diagnosis, Diagnóstico, Dyslipémie, Dyslipemia, Dislipemia, Facteur risque, Risk factor, Factor riesgo, Femelle, Female, Hembra, Hypertension artérielle, Hypertension, Hipertensión arterial, Mortalité, Mortality, Mortalidad, Ménopause, Menopause, Menopausia, Obésité, Obesity, Obesidad, Prévention, Prevention, Prevención, Tabac, Tobacco, Tabaco, Traitement, Treatment, and Tratamiento

Cardiovacular disease, primarily coronary heart disease (CHD), outnumbers the next 16 causes of death in women combined. However, the long-held belief that heart disease in women has a more benign prognosis than in men has resulted in less aggressive diagnosis and management patterns. Appreciation of the differences between men and women in CHD risk factors and presentation can assist in treatment decisions. Although estrogen replacement offers substantial beneficial effects on lipid levels in postmenopausal women, the first 2 randomized trials of estrogen alone and estrogen plus progestin, the Heart and Estrogen/Progestin Replacement Study and Estrogen Replacement and Atherosclerosis Study, observed no benefit in reducing risk of CHD death and nonfatal myocardial infarction and angiographic progression of CHD, respectively, in women with CHD. Available data show that lipid-lowering therapy reduces women's CHD risk and mortality but also indicate that a considerable proportion of women remains untreated or undertreated. Randomized trials of statins for primary and secondary prevention of coronary heart disease suggest that these agents are at least as effective for lowering coronary disease risk in women as in men. Therefore, statin drugs should be the drug of first choice for women with established CHD. Hypercholesterolemic postmenopausal women who require estrogen for menopausal symptoms may derive further reductions in low-density lipoprotein cholesterol and reductions in trigyceride levels with the addition of a statin drug.

Endocrinology, Endocrinologie, Nutrition, obesity, metabolic disorders, Nutrition, obésité, maladies métaboliques, Sciences biologiques et medicales, Biological and medical sciences, Sciences biologiques fondamentales et appliquees. Psychologie, Fundamental and applied biological sciences. Psychology, Vertebres: anatomie et physiologie, organisme dans son ensemble ou etude de plusieurs organes ou systemes, Vertebrates: anatomy and physiology, studies on body, several organs or systems, Alimentation. Comportement alimentaire, Feeding. Feeding behavior, Alimentation, Feeding, Alimentación, Lipide, Lipids, Lípido, Macronutriment, Macronutrient, Macronutriente, Acide gras saturé, Saturated fatty acid, Acido graso saturado, Apolipoprotéine AIV, Apolipoprotein AIV, Apolipoproteína AIV, Cholestérol, Cholesterol, Colesterol, Education nutritionnelle, Nutrition education, Educación nutricional, Homme, Human, Hombre, Lipoprotéine, Lipoprotein, Lipoproteina, Métabolisme, Metabolism, Metabolismo, Programme, Program, Programa, Régime alimentaire restrictif, Restricted diet, Régimen alimenticio restrictivo, Triacylglycérol, Triacylglycerol, and Triacilglicerol

Background: Apolipoprotein (apo) A-IV is a major component of triacylglycerol-rich lipoprotein (TRL) apolipoproteins. Objective: We investigated the effects of dietary saturated fat and cholesterol restriction on the metabolism of TRL and plasma apo A-IV. Design: We assessed TRL and plasma apo A-IV kinetics in 16 and 4 subjects, respectively, consuming an average US (baseline) diet for 6 wk and a National Cholesterol Education Program Step II diet for 24 wk, respectively. At the end of each diet period, all subjects received a primed, constant infusion of deuterated leucine for 15 h with hourly feeding. Ratios of stable-isotope tracer to tracee were measured by using gas chromatography-mass spectrometry, and kinetic data were modeled by using SAAM II. Results: Mean apo A-IV concentrations during the isotope infusion period were 6.9 ± 2.6 mg/L in TRL and 2.2 ± 3.2 mg/L in plasma with the baseline diet; these values were 37.7% (P <0.001) and 19.4% (P <0.01) lower with the Step II diet. Similar changes were observed in the fasting state between the 2 diets. The mean apo A-IV secretion rate decreased significantly from baseline by 59.6% in TRLs and by 40.2% in plasma. Significant correlations were observed between TRL apo A-IV concentrations and the secretion rate (r = 0.94, P < 0.001) and between TRL apo A-IV pool size and TRL-cholesterol concentrations (r = 0.48, P < 0.01). Conclusions: Our data indicate that the National Cholesterol Education Program Step II diet significantly decreases TRL and plasma apo A-IV concentrations compared with the average US diet and that this decrease is due to a decreased secretion rate.

TRANSLUMINAL angioplasty and MORTALITY

Women have a higher in-hospital mortality rate than men after percutaneous transluminal coronary angioplasty (PTCA). To determine reasons for this, we analyzed the outcome of PTCA at our institution from 1989 to 1995 for 5,989 patients (2,101 women). Women were older than men (66.8 +/- 10.9 vs 61.0 +/- 11.2 years, respectively; p <0.0001) and more likely to have diabetes mellitus, hypertension, or a history of congestive heart failure than men. In-laboratory complications at the time of PTCA were similar for women and men. During the first 24 hours after PTCA, women were more likely than men to become hypotensive (0.33% vs 0.08%, p = 0.04) and had a higher rate of vascular injury than men (1.6% vs 0.6%, p <0.001). More than 24 hours after the procedure, women had a significantly higher mortality rate (1.2% vs 0.52%, p = 0.017), which was no longer significantly different after adjustment for age (odds ratio 0.72, 95% confidence interval 0.39 to 1.32). Multivariate correlates of death >24 hours after PTCA were age, a prior history of congestive heart failure, vascular injury, and use of thrombolytic agents. Of those dying >24 hours after the procedure, 67% of women suffered a noncardiac-related death compared with only 10% of men (p <0.001). The noncardiac death rate was 0.8% for women and 0.05% for men. These deaths were related to renal failure, vascular complications, bleeding, hypotension, and stroke, especially hemorrhagic stroke. In conclusion, immediate procedural complications at PTCA were similar for women and men; however, mortality was higher for women >24 hours after PTCA and before discharge due to a higher rate of noncardiac death. [ABSTRACT FROM AUTHOR]

Cardiology, blood circulation, phlebology, Cardiologie, appareil circulatoire, phlébologie, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Maladies metaboliques, Metabolic diseases, Dyslipémies. Hyperlipoprotéinémies, Disorders of blood lipids. Hyperlipoproteinemia, Appareil urinaire pathologie, Urinary system disease, Aparato urinario patología, Enzyme, Enzima, Hypolipémiant, Antilipemic agent, Hipolipemiante, Métabolisme pathologie, Metabolic diseases, Metabolismo patología, Néphropathie glomérulaire, Glomerulonephritis, Nefropatía glomerular, Oxidoreductases, Rein pathologie, Kidney disease, Riñón patología, Aminoacide, Aminoacid, Aminoácido, Apolipoprotéine B, Apolipoprotein B, Apolipoproteína B, Chimiothérapie, Chemotherapy, Quimioterapia, Dyslipémie, Dyslipemia, Dislipemia, Efficacité traitement, Treatment efficiency, Eficacia tratamiento, Exploration, Exploración, Homme, Human, Hombre, Hydroxymethylglutaryl-CoA reductase, Inhibiteur enzyme, Enzyme inhibitor, Inhibidor enzima, Isotope, Isotopes, Isótopo, Lipide, Lipids, Lípido, Marquage, Tagging, Marcación, Métabolisme, Metabolism, Metabolismo, Néphrotique syndrome, Nephrotic syndrome, Nefrótico síndrome, Physiopathologie, Pathophysiology, Fisiopatología, Précurseur métabolique, Metabolic precursor, Precursor metabólico, Revue bibliographique, Bibliographic review, Revista bibliográfica, Traitement, Treatment, and Tratamiento

This article reviews the literature from 1986 to early 2001 relating to apoB100 and apoB48 kinetics in humans using amino acid precursors labeled with stable isotopes. The following subjects are reviewed: (1) methodology; (2) normal individuals and the effects of aging; (3) diet; (4) hereditary dyslipidemias: familial hypercholesterolemia, familial combined hyperlipidemia, cholesteryl ester storage disease, cholesteryl ester transfer protein deficiency, lipoprotein lipase deficiency, familial hypobetalipoproteinemia, and truncated forms of apoB; (5) hormonal perturbations: estrogen, insulin, diabetes, obesity, and growth hormone; (6) the nephrotic syndrome; and (7) the effects of the statin class of drugs. Because of the advances which have been made in mass spectrometry techniques, the advantages of using non-radioactive tracers in humans have made stable isotope kinetic studies the present day standard in this area of research.

Cardiology, blood circulation, phlebology, Cardiologie, appareil circulatoire, phlébologie, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Cardiologie. Appareil circulatoire, Cardiology. Vascular system, Coeur, Heart, Cardiopathie coronaire, Coronary heart disease, Appareil circulatoire pathologie, Cardiovascular disease, Aparato circulatorio patología, Cardiopathie coronaire, Coronary heart disease, Cardiopatía coronaria, Cholestérol HDL, Cholesterol HDL, Colesterol HDL, Cholestérol LDL, Cholesterol LDL, Colesterol LDL, Etude comparative, Comparative study, Estudio comparativo, Etude longitudinale, Follow up study, Estudio longitudinal, Exercice physique, Physical exercise, Ejercicio físico, Facteur risque, Risk factor, Factor riesgo, Homme, Human, Hombre, Mode de vie, Life style, Modo de vida, Régime alimentaire, Diet, Régimen alimentario, Sexe, Sex, Sexo, Traitement, Treatment, and Tratamiento

In summary, the addition of an average of 30 minutes daily exercise to a TLC diet resulted in 89% of subjects reaching acceptable LDL cholesterol goals, without lowering HDL cholesterol, and obviated the need to add or increase lipid-lowering medications. Our results should encourage practitioners to prescribe exercise and weight loss, in addition to a TLC diet, to achieve LDL cholesterol goals. Our results also provide substantial information about the optimal way to carry out a life-style modification program.

Biochemistry, molecular biology, biophysics, Biochimie, biologie moléculaire, biophysique, Organic chemistry, Chimie organique, Metrology and instrumentation, Métrologie et instrumentation, Sciences biologiques et medicales, Biological and medical sciences, Sciences biologiques fondamentales et appliquees. Psychologie, Fundamental and applied biological sciences. Psychology, Vertebres: anatomie et physiologie, organisme dans son ensemble ou etude de plusieurs organes ou systemes, Vertebrates: anatomy and physiology, studies on body, several organs or systems, Métabolismes et régulations neurohumorales, Metabolisms and neurohumoral controls, Métabolisme intermédiaire et énergétique, Intermediate and energetic metabolism, Article synthèse, Review, Artículo síntesis, Composition corporelle, Body composition, Composicíon corporal, Dépense énergétique, Energetic cost, Costo energético, Isotope, Isotopes, Isótopo, Métabolisme énergétique, Energy metabolism, Metabolismo energético, Méthode analyse, Analysis method, Método análisis, Obésité, Obesity, Obesidad, Spectrométrie masse, Mass spectrometry, Espectrometría masa, metabolism, obesity, and stable isotopes

Obesity is recognized as a major public health problem. Obesity is a multifactorial disease and is often associated with a wide range of comorbidities including hypertension, non-insulin dependent (Type II) diabetes mellitus, and cardiovascular disease, all of which contribute to morbidity and mortality. This review deals with stable isotope mass spectrometric methods and the application of stable isotopes to metabolic studies of obesity. Body composition and total energy expenditure (TEE) can be measured by mass spectrometry using stable isotope labeled water, and the metabolism of protein, lipid, and carbohydrate can be measured using appropriate labeled tracer molecules.