A case report of the cascade filtration system: A safe and effective method for low-density lipoprotein apheresis during pregnancy

PubMedID: 18937724Women with familial hypercholesterolemia (FH) should be treated effectively during pregnancy, as elevated low-density lipoprotein cholesterol (LDL-C) levels may result in life-threatening consequences. Hydroxymethylglutaryl- coenzyme A reductase inhibitors are contraindicated during pregnancy, therefore LDL apheresis should be considered in the management of such pregnant cases. There are five different methods of selective LDL apheresis: heparin-induced extracorporeal LDL precipitation, double filtration plasmapheresis, direct adsorption of lipoproteins, dextran sulfate adsorption, and LDL immunoadsorption. The cascade filtration system is another modern and effective method for the extracorporeal elimination of LDL-C, although it is not as selective as the methods mentioned above. Herein, we present the case of a pregnant woman with heterozygous FH and extremely elevated LDL-C levels who has been successfully treated with the cascade filtration system until delivery. As far as we can ascertain, LDL apheresis with the cascade filtration system during pregnancy has not yet been reported in the literature. © 2008 The Authors

Miliary tuberculosis in a pregnant woman who is on hemodialysis: Case report

Miliary tuberculosis is rare during pregnancy. A 34-ye ar-old multipara woman on hemodialysis for chronic renal failure presented with fever and cough. Although the chest X-ray was suggestive of tuberculosis, the skin test and the sputum smear were negative and the patient was initially treated for bacterial pneumonia. Mycobacterium tuberculosis was detected in blood culture 4 days later. The patient was put on anti-tuberculosis treatment and continued hemodialysis. She was followed up weekly and the pregnancy was uneventful until she was admitted with preterm labor at the 27th week. She responded to tocolytic treatment initially. After the induction of pulmonary maturity, to colysis was discontinued and the patient delivered an 860-gram female baby who did well after a long time in neonatal intensive care unit. Copyright © 2010 by Türkiye Klinikleri

Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study

BACKGROUND: Elevated levels of plasma homocysteine (Hcy) have been implicated as a significant risk factor for cardiovascular disease. Although long-term treatment with metformin can increase Hcy levels in patients with type II diabetes mellitus or coronary heart disease, it is becoming an increasingly accepted and widespread medication in polycystic ovary syndrome (PCOS). In the literature, only one study has demonstrated that metformin increases Hcy levels in PCOS patients, but the effect of other insulin sensitizers on Hcy levels have not been reported previously in women with PCOS. We aimed to assess the effects of metformin and rosiglitazone on plasma Hcy levels in patients with PCOS. METHODS: Thirty women were randomized to two groups: 15 women in group 1 received 850 mg of metformin twice daily for 3 months. In group 2, 15 women received 4 mg of rosiglitazone for 3 months. In both groups, body mass index, menstrual pattern, and plasma total Hcy, insulin, glucose and lipid metabolism parameters were recorded at baseline and at 3 months. RESULTS: Hcy levels increased from 8.93 6 0.49 to 11.26 6 0.86 mmol/l (P 5 0.002) and from 10.70 6 0.86 to 12.36 6 0.81 mmol/l (P 5 0.01) in the metformin and rosiglitazone groups, respectively. Apolipoprotein (Apo) A1 levels increased from 127.10 6 6.85 to 145.7 6 7.18 mg/dl (P 5 0.018) in the metformin group. Total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and Apo B levels decreased in the metformin group, but the change was not significant. Total-C levels decreased from 161.15 6 8.94 to 150.23 6 8.73 mg/dl (P 5 0.026), HDL-C decreased from 43.13 6 2.65 to 39.15 6 2.52 mg/dl (P 5 0.005) and LDL-C levels decreased from 93.83 6 6.06 to 80.7 6 2.30 mg/dl (P 5 0.021) in the rosiglitazone group. CONCLUSION: Treatment with insulin sensitizers in women with PCOS may lead to increases in Hcy levels