Compression of the Duodenum by the Root of the Mesentery

Compression of the duodenum by the root of the mesentery is a rare pathological entity that has caused much controversy because it has been mistakenly identified as the superior mesenteric artery syndrome or the vascular compression of the duodenum. We discuss the pathological anatomy and the diagnosis of the disease, and report an illustrative case. Some authors report many cases of the syndrome, while others doubt its existence. Before surgery is considered, the diagnosis should be established beyond doubt and a prolonged period of observation, medical treatment, and nutritional support should be provided. The barium contrast swallowing test combined with aortographic studies can pinpoint the compression site behind the root of the mesentery. Good surgical results have been reported with both dextroposition of the duodenojejunal junction and with duodenojejunostomy

Efficacy and safety of pravastatin in the long-term treatment of elderly patients with hypercholesterolemia

Elevated cholesterol levels are a major risk factor for coronary heart disease, which remains a significant problem in patients beyond age 65 years. Because drug therapy for the control of hypercholesterolemia in elderly patients is frequently considered to be indicated, we investigated the efficacy and safety of pravastatin in the treatment of elderly subjects with primary hypercholesterolemia. In this 96-week, multicenter, double-blind, placebo-controlled study, 142 subjects (95 women, 47 men) 64 to 90 years of age with elevated cholesterol levels despite dietary intervention were randomized to receive pravastatin 20 mg at bedtime or matching placebo (2:1). Dosage could be doubled after 8 weeks, a bile acid-binding resin could be added after 16 weeks, and nicotinic acid or probucol could be added after 32 weeks, as needed, to adequately lower the low-density lipoprotein cholesterol (LDL-C) levels. Significant reductions in the levels of LDL-C (-30.9%), total cholesterol (Total-C; -21.9%), and triglycerides (TG; -16.7%) and significant increases in the levels of high-density lipoprotein cholesterol (HDL-C; 11.3%) were noted in the group receiving pravastatin treatment at 16 weeks (P In this study, pravastatin was well tolerated and effective in lowering LDL-C, Total-C, and TG and in raising HDL-C during long-term treatment of elderly patients with primary hypercholesterolemia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31935/1/0000888.pd

Elevated Serum Transaminase as a Presenting Clue for Precirrhotic Hemochromatosis

For patients in whom unexplained elevations in SGOT and SGPT concentrations are found, determination of the serum iron level is recommended to screen for asymptomatic precirrhotic hemochromatosis. Care must be taken to differentiate between hereditary hemochromatosis and secondary iron accumulation due to liver disease

The Effect of Pravastatin on Plasma Lipoprotein and Apolipoprotein Levels in Primary Hypercholesterolemia

Pravastatin is a metabolic product of mevastatin and a potent inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase. It was investigated for its cholesterol-lowering properties in a double-blind, placebo-controlled, multicenter study of 82 patients with primary hypercholesterolemia. Following a 6- to 8-week dietary lead-in period, patients were randomized to twice-daily placebo or active drug for 16 weeks. Patients receiving 10 mg of pravastatin twice a day for 8 weeks experienced mean total cholesterol and low-density lipoprotein cholesterol (LDL-C) level reductions of 20% (6.85 vs 5.48 mmol/L [265 vs 212 mg/dL]) and 28% (5.17 vs 3.75 mmol/L [200 vs 145 mg/dL]), respectively. At 20 mg twice a day for an additional 8 weeks, pravastatin reduced plasma total cholesterol, LDL-C, and apolipoprotein B-100 levels by 23% (6.85 vs 5.30 mmol/L [265 vs 205 mg/dL]), 31% (5.17 vs 3.59 mmol/L [200 vs 139 mg/dL]), and 23% (118 vs 91 mg/dL), respectively. Highdensity lipoprotein cholesterol (HDL-C), HDLb-C, HDL and apolipoprotein A-I plasma concentrations increased by 11%, 60%, 7%, and 10%. Plasma triglyceride concentrations decreased in both the pravastatin- and placebo-treated patients. Pravastatin was generally well tolerated and an effective agent for the treatment of primary hypercholesterolemia.(Arch Intern Med. 1991;151:2234-2240