Another piece of the fish oil puzzle

Microcoil embolization of an arteriovenous fistula from the arteria bulbi penis to the corpus spongiosum penis in the treatment of erectile dysfunction: normal function regained immediately after intervention

A 39-year-old man presented with erectile dysfunction that had persisted since its sudden onset 5 years ago. He exhibited none of the classic risk factors, and all attempts at medication had been unsuccessful. An ultrasound examination revealed the presence of an arteriovenous shunt in the corpus spongiosum penis. Selective digital subtraction angiography of the left internal pudendal artery showed an arteriovenous fistula from the arteria bulbi penis to the corpus spongiosum penis. The outflow of venous blood took place via the penile veins into the periprostatic vein plexus. Superselective catheterization of the arteria bulbi penis was performed with a 3 French coaxial catheter (Topaz Micro Coils; Micro Therapeutics, Inc, Irvine, CA) and it was occluded by inserting several platinum coils. 1 week after the procedure, the patient reported normal erectile function, which was subsequently maintained.

Prevention of coronary heart disease. Part II. Secondary prevention, detection of subclinical disease, and emerging risk factors

The prevention of CHD should be a major priority among primary care physicians and subspecialists who have any dealing with the cardiovascular system. There is ample evidence from epidemiologic studies for the impact of specific risk factors on CHD events. There is also ample evidence from observational studies and clinical trials that interventions of lifestyle and pharmacologic therapy can decrease morbidity and mortality from CHD before or after the first event. It behooves the physician who wishes to practice good medicine to understand the pathophysiologic roles of the risk factors and the evidence from epidemiologic studies and clinical trials for their association with cardiovascular disease. It is important to determine the efficacy of interventions, both lifestyle and pharmacologic, in modifying CHD risk. To be effective in doing so, the practicing physician has to have the motivation to determine target goals for risk factor modification in each patient, to understand the patient's own motivations in modifying risk factors, and to define clearly with the patient the expectations of such interventions. Although there are guidelines for risk factor modification in modification of cholesterol and in hypertension, the periodic renewal of these guidelines reflects the changing concepts of risk and its modification. A cardiovascular risk factor intervention categorization is presented in Table 12. The physician must be convinced that such intervention is beneficial to the patient, cost-effective, and thus fulfills the expectations of medical practice. The practice of medicine in the evaluation and treatment of coronary heart disease has always been challenging and stimulating. The prevention of CAD disease should ultimately provide the greatest accomplishment.

The influence of dietary n-3 fatty acids on plasma lipids and lipoproteins

The body of epidemiologic data indicates that the incidence of cardiovascular disease is lower in populations whose habitual diet is rich in fish. It is unclear however to what extent this apparent protection is due to the intake of n-3 fatty acids in sea food or to the fact that these subjects have generally been consuming lower amounts of saturated fatty acids in their diets. It is clear, however, that when the dietary intake of n-3 fatty acids is increased to 4-8 g/day distinct metabolic effects are observed, including reductions in plasma triglycerides, effects on platelet function and coagulation factors and blood pressure. Larger intakes exert a more profound hypotriglyceridemic effect, and in patients with primary hypercholesterolemia daily intakes exceeding 10-12 g/day are effective in reducing plasma concentrations of LDL cholesterol. However, from a practical point of view, the lipid-modifying effects of supplemental dietary n-3 fatty acids are most clearly observed in patients with hypertriglyceridemia and the major usefulness of dietary n-3 fatty acids is in the treatment of this patient population, particularly patients with severe hypertriglyceridemia or potentially those with Type III hyperlipoproteinemia. Further studies are needed to better define the potential utility of dietary n-3 fatty acids when used in combination with lipid-lowering drugs to reduce lipoprotein concentrations in patients with combined hyperlipoproteinemia or severe hypertriglyceridemia.

The absorption of fish oils and concentrates

Both preventive and curative therapies have created a considerable demand for eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. The most common sources for omega 3 fatty acids are fish oil. The concentrations of EPA and DHA in commercial oils, after modest enrichment, reach about 300 mg/g; alternative technologies can produce reasonably priced fish oils containing 400 or even 500 mg/g of omega 3 acids. When the acids are liberated from the glycerides, concentrates of ethyl esters or free acids with 65 to 70% total omega 3 fatty acids (at least 50% EPA + DHA) are readily prepared. Difficulties have arisen because most clinical trials have used fish oils of unspecified composition, and some trials are now based on either ethyl esters or free acids. There are at least three different, but not mutually exclusive, absorption routes in humans, namely the preduodenal route, the lymphatic route via chylomicrons, and the route via the portal vein to the liver. This makes it difficult to compare results. The difficulty in obtaining dose-related clinical data may in part be due to the form in which the omega 3 acids are offered and due in part to the natural presence of these fatty acids in the body. The nontriglyceride forms, especially the free acids, have been advocated for standardization of trials to facilitate interlaboratory comparisons.