Impaired fibrinolytic activity is present in children with dyslipidemias

Dyslipidemias are major risk factors for atherosclerosis and cardiovascular disease. Abnormalities of fibrinolytic and coagulation components are considered useful predictors of cardiovascular morbidity and mortality in adults. This study examined whether fibrinolytic and coagulation components are abnormal in children with dyslipidemia. Thirty-six children with asymptomatic dyslipidemia, and 26 control subjects underwent venous occlusion stress testing with collection of preocclusion and postocclusion blood samples. All samples were assayed for tissue plasminogen activator, plasminogen, plasminogen activator inhibitor-1, alpha(2)-antiplasmin, alpha(2)-macroglobutin, D-dimer, fibrino-gen, and von Willebrand factor. Children with dyslipidemia had significantly decreased levels of tissue plasminogen activator in both preocclusion and postocclusion samples compared with control subjects, reflecting decreased fibrinolytic activity. Children with dyslipidemia also had significantly increased levels of plasminogen, alpha(2)-macroglobulin, and fibrinogen in preocclusion and postocclusion samples compared with control subjects. In conclusion, decreased fibrinolytic activity is present in asymptomatic children with dyslipidemias, potentially reflecting endothelial dysfunction and increased risk of cardiovascular disease in early adult life. Further studies are required to determine the usefulness of this marker in predicting disease progression or response to therapy

Management of acute injuries of the tibiofibular syndesmosis

The syndesmosis is important for ankle stability and load transmission and is commonly injured in association with ankle sprains and fractures. Syndesmotic disruption is associated with between 5 and 10% of ankle sprains and 11-20% of operative ankle fractures. Failure to recognize and appropriately treat syndesmotic disruption can portend poor functional outcomes for patients; therefore, early recognition and appropriate treatment are critical. Syndesmotic injuries are difficult to diagnose, and even when identified and treated, a slightly malreduced syndesmosis can lead to joint destruction and poor functional outcomes. This review will discuss the relevant anatomy, biomechanics, mechanism of injury, clinical evaluation, and treatment of acute injuries to the ankle syndesmosis