P269 A case of hepatocellular damage during treatment with pioglitazone

Abstracts disease, frequently rarely associated

I European

Journal

associated with diabetes, localized or disseminated with systemic disease like sarcoidosis.

P268 Effect of benazepril amlodipine pertensive diabetic patients R. Fogari, P. Lazzari. L. Corradi, Mugellini (Pavia, I)

combination A. Zoppi,

on fibrinolysis P. Preti,

A.

of Internal and

in hyRinaldi,

A.

The aim of this study was to evaluate the effect of benazepril-amlodipine combination on plasma tissue plasminogen activator (t-PA) and inhibitor 1 (PAI-1) activity in hypertensive type 2 diabetic patients. After a 4 week placebo run-in period 30 hypertensive patients (DBPz955 105 mmHg) with well controlled type 2 diabetes were randomized to benazepril 10 mg or amlodipine 5 mg or benazepril amlodipine combination according to a 3 X 3 cross over design; each treatment had a 4 week duration. The last day of the placebo run-in period and of each treatment period blood pressure was measured and a venous blood sample was taken (at the same hour in the morning) to evaluate plasma PAIand t-PA activity. The results are shown in the table.

SBP (m,nHg) DBP immHg1 Plwl ICllnli I-l?4 (Uliml) :l pao5:

*i- p
These results suggest that in patients with impaired fibrinolysis an ACE inhibitor-Ca blocker combination improve the fibrinolysic balance more than the single monotherapies. It represents a further indication to the use of ACE inhibitor-Ca blocker combination in diabetic hypertensive patients, where it is difficult to reach the required blood pressure target with a single drug.

P269 A case of hepatocelhdar damage during treatment Cl. Skaragkas, D. Karagianni, C. Manes, S. Goutkidou, Eustratiou, E. Skaragka (Thessaloniki, GR)

with pioglitazone S. Karakoulakis,

Medicine

14 (2003)

s107

Sl-S159

were normal, and the liver biopsy revealed steatohepatitis with moderate grade of fibrosis and cholestasis. After the discontinuation of all drugs, hepatic function was maintained in normal levels. Pioglitazone was considered to be the main responsible drug for the above findings as the patient had been receiving lovastatin for many years, Conclusion: Pioglitazone treatment may cause serious liver damage (cholestatic hepatitis), which, in this case was reversible. The combination of pioglitazone and lovastatin treatment on liver function is still unidentified.

P270 Obesity and metabolic factor P. Deibert, D. Konig, (Freiburg, D)

risk I. Frey,

- serum

triglycerides

U. Landmann,

H.-H.

as a discriminative Dickhuth,

A. Berg

Obesity is a major precondition for the development of the metabolic syndrome. In the present study we investigated the prevalence of metabolic risk factors (MRF) in 83 overweight subjects of both genders (BMI 31.452.2 kg/m’; age 47557.5 years). The following parameters were determined after an overnight fast: Total chol. (CHOL), triglycerides (TG), LDL chol. (LDL), HDL chol. (HDL), glucose (GLUK), insulin (INS), interleukin-6 (IL-6). tumor necrosis factor alpha (TNF-alpha) and C-reactive protein (CRP). In addition, fat mass was determined by Bod Pod; systolic (sys) and diastolic (dia) blood pressure (RR) was measured in the supine position after 10 min of rest. As increased TG-concentrations are an important determinant of the metabolic syndrome, two subgroups were formed: Group 1: normal TG (TG< 150 mg/dl; n=55); group 2: increased TG (TG> 150 mg/dl; n = 28). BMI and fat mass did not differ significantly between the groups. However, subjects with TG> 150 mg/ml showed distinct higher MRF (TG: 208259 vs. 100227 mg/dl, p 150 mg / dl) yields in a good discrimination between overweight persons with and without increased MRF. In conclusion, the data from our study suggest, that measuring TG levels in obese subjects may serve as a fast and cheap method to distinguish between normal and increased MRF and that determination of body composition does not yield additional information.

I.

Pioglitazone is a new drug for the treatment of type II diabetes mellitus, classified in Thiazolithinediones and acts by improving insulin sensitivity in adipose tissue, liver and skeletal muscles. So far, only two cases of liver dysfunction associated with pioglitazone treatment have been reported. A case of a 65.year-old woman suffering from diabetes mellitus since 24 years and recently treated with pioglitazone is described. The patient was initially admitted in the Surgery Department of our Hospital, as biochemical tests indicating obstructive jaundice were found. No cause of obstructive jaundice was detected and the patient was transmitted to our clinic for the identification of liver damage. She was receiving pioglitazone for four months in combination with metformin while lovastatin was included in her treatment for many years, There was no history of alcohol use. Abnormal liver function tests were as follows: cholerythrin: 13.7 mg/dl (non-conjunctive 6.5 mg/dl), AST: 177 U/L, ALT: 237U/L, aCT: 2078 U/L, alkaline phosphatase 47OU/L. Control for hepatitis B and C virus was negative. A CT scan and MRI of the liver

P271 The significance of diabetes mellitus on latter thromboembolic stroke in Greek population S. Paximadas, S. Pagoni, M. Kosmidis, N. Tentolouris, N. Sakarellou, D. Moutafis. N. Joakimidis (Athens, GR) Purpose: Investigated the exact impact of diabetes mellitus (D.M.) on patients with latter acute thrombolic or embolic stroke episode in Greek population. Material and methods: 737 inpatients with latter acute thrombolic or embolic stroke episodes, 399 females (F) and 346 males (M) aged 76& 10 years (40-100 years) were studied. Recorded the presence D.M., Blood Press (B.P.), Smoke, Alcohol, Old Stroke, Progress (stagnation, improved and death) and lipid profile, as Total Cholesterol (TC), Triglycerides (TG). HDL-Cholesterol (HDL-C), and LDL-Cholesterol (LDL-C). All patients belong to our Internal Medicine Clinic and results were analyzed in the same laboratory. Results: D.M. 40% (56% F-44% M), B.P. 79%, Smoke 24% (13%