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Summary An adult patient with congenital malrotation of the gut, presenting as duodenal obstruction is reported.
BRITISH MEDICAL JOURNAL 23 SEPTEMBER 1972 733 were included in the analysis. Elwood et al. found that women with a haemoglobin below 10-5 g/100 ml had a cholesterol value that on the average was 30 mg/100 ml lower than in women with normal haemoglobin values. By using the regression equation in Table III for women aged 20-54 it can be calculated that a lowering of the haemoglobin from a normal of 14 g/100 ml to a low normal of 11 g would mean a decrease in the cholesterol value of 18 mg/100 ml, a figure of the same order of magnitude as that of Elwood et al. The same correlation was found for serum triglyceride values. The relation was also found in men both for cholesterol and for triglyceride, a finding not previously reported.The variations in serum lipid values with the haemoglobin levels previously seen in anaemia have not been explained. They may, of course, be coincidental and largely independent of each other. As pointed out by Elwood et al., 1970, possibly the lower haemoglobin levels in women might be connected with lower serum lipid values, and this could partly explain the lower incidence of ischaemic heart disease in premenopausal women and of people in developing countries.Possibly part of the relation between cholesterol and haemoglobin values in women, now extended to include also triglycerides, and men may be explained by changes in plasma volume. If we assume that the blood volume remains unchanged as the haemoglobin in women decreases from 14g to 11 g/l00 ml, as quoted above, the packed cell volume would decrease from 40 to 32%/ and thus the plasma volume would increase from 60 to 68%. If in women the total plasma pool of cholesterol and triglycerides were unchanged and the concentration of cholesterol was 250 mg/100 ml and triglycerides of 1410 mmol/l. with a packed cell volume of 40%, the values would decrease to 220 mg/100 ml and 0 97 mmol/l. if the packed cell volume went down to 32%. Thus a change in plasma volume could be predicted to lower serum cholesterol and triglyceride values by 30 mg/100 ml and 013 mmol/l. respectively. From the equations in Table III the corresponding figures can be calculated to be 18 mg/100 ml for cholesterol and 0-13 mmol/l. for triglycerides.Assuming unchanged total plasma pools corresponding figures for men would be by calculation 30 mg/100 ml and 0 19 mmol/l. and by the regression equation (Table III) Gale (1967), who showed that the decrease in serum cholesterol and phospholipids was not due to a specific lowering of any one of the serum lipoprotein families but was caused by a proportionate fall in all three of the major lipoprotein families, a finding which is indeed compatible with a plasma volume dependent effect.
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