Risk factors of coronary heart disease: West German data

While death rates of myocardial infarction are largely constant in the United States, there has been a continuous increase since the war in the Federal Republic of Germany as well as other European countries. This applies to males and females, although the increase is especially high in younger women. In contrast to falling death rates due to hypertension in the U.S. and some European countries, there is no change in Germany. In conjunction with a study by WHO in which Heidelberg is one center, the time interval between the onset of the myocardial infarction and death is investigated. The mortality rate is extremely high in the first few minutes and hours. Within one month after the attack, 59% of males and 54% of females have died, about half of the deaths occurring within the first hour. During the first hour, 65% of the patients decide to call a doctor. In a group of male cases below age 40, the risk factors of cigarette smoking, hyperuricemia, hypertension, and diabetes are more prevalent than in controls. In smokers, myocardial infarction occurs at a younger age than in nonsmokers. Cases with myocardial infarction have a lower job-related physical activity score than controls. A psychological pattern was found in patients with myocardial infarction, showing them to be anxious, inflexible, and socially over-adaptive, while, at the same time, fearing contact.     

Das eosinophile Granulom der Orbita

Zusammenfassung Das eosinophile Granulom findet in der Pathologie der Orbita in den letzten Jahren eine immer stärkere Beachtung. Da die Kenntnis des Krankheitsbildes noch nicht allgemein verbreitet ist, kann sicher ein großer Teil der Fälle nicht ohne operativen und histologischen Befund diagnostiziert werden und ist deshalb in der großen Gruppe der Pseudotumoren enthalten.Die Prognose der Erkrankung ist in der Regel sehr gut. Die meisten Granulome vernarben nach einem Verlauf von mehreren Wochen bis Monaten, allenfalls weniger Jahre ohne Residuen, oft auch spontan. Um so wichtiger ist es, bei dem bevorzugten Befall von Jugendlichen und Kindern eine Verwechslung mit einem Sarkom der Orbita zu vermeiden. Dazu kann der manchmal sehr rasche klinische Verlauf und die schnell einsetzende und fortschreitende Osteolyse bei kurzfristigen Röntgenkontrollen oft begründeten Anlaß bieten.Die Geschlechtsverteilung der Erkrankung ist etwa gleich. — Ihre Ätiologie ist unbekannt.In unserer Arbeit beschrieben wir eine eigene Beobachtung und werteten die kasuistischen Mitteilungen des Weltschrifttums aus. Klinisch stehen die Trias Ptosis, rasch sich entwickelnder Exophthalmus in den Grenzen von 2–7 mm und stechender Schmerz im Vordergrund. Falls kein axialer Exophthalmus vorliegt, kann es durch Deplazierung des Bulbus zu Doppelbildern kommen, die jedoch durch die begleitende Ptose zum Teil unterdrückt werden. Eine Visusbeeinträchtigung und Veränderung der brechenden Medien besteht nicht. Bei Beteiligung der Orbitaspitze kann es jedoch zu raschem Visusverfall und durch Analgetika nicht zu beherrschenden Schmerzen kommen.Charakteristisch für das eosinophile Granulom ist die sich rasch bis zur Höhe des Krankheitsbildes entwickelnde Symptomatik, während alle übrigen raumfordernden Prozesse, auch die lymphatischen Tumoren, in der Regel langsamer wachsen. Nach einem Verlauf von etwa 3 Wochen ist das Krankheitsbild in der Mehrzahl der Fälle voll ausgebildet. Das Blutbild und die laborchemischen Befunde geben entgegen der allgemeinen Annahme oft keinen Hinweis für die Diagnose.Auf den Röntgenbildern mit Orbitaeinstellung kann man meistenteils, falls nicht reiner Weichteilbefall vorliegt, wie in unserem Fall, einen osteolytischen Herd ohne Randsklerose sehen, der bei Kontrolle rasch fortschreitet.Therapeutisch kann eine probatorische Röntgenbestrahlung von 200 bis 500 r empfohlen werden. Bei Ansprechen kann diese, soweit nötig, bis etwa 2000 r fortgesetzt werden. — Resistente Prozesse und solche mit raschem Visusverfall bedürfen des frühzeitigen operativen Eingriffs. Ganz leicht verlaufende Fälle können symptomatisch mit Analgetika behandelt werden.Einschränkend muß für die probatorische Röntgenbestrahlung unbedingt hinzugefügt werden, daß der Patient in weiterer Kontrolle des behandelnden Ophthalmologen bleiben muß, um einen evtl. bösartigen Prozeß nicht zu übersehen.

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Summary The eosinophilic granuloma has attained increasing significance in the pathology of the orbita during recent years. Because of its as yet little known clinical picture, the great majority of cases cannot be diagnosed without surgical and histological examinations and it is for this reason that it is classified as belonging to the group of pseudotumours.The prognosis of the illness is usually good. Most of the granulomas heal within several weeks, months or years without sequelae, and they may do so even spontaneously.It is very important not to mistake this disorder for a sarcoma of the orbita, especially within the juvenile age group.In this paper we have described a case of our own and evaluated the casuistics of the world literature trying to establish a disease pattern that may facilitate the recognition of the eosinophilic granuloma of the orbita with greater certainty.The clinical symptomatology, x-ray findings, laboratory findings, and the different therapeutic possibilities are reported.Especially, we discussed the question whether to use irradiation or surgery for therapy, envisaging the implications and risks involved.Generally, an attempt with x-ray treatment in doses of 200–500 r can be recommended. If a positive reaction is obtained the doses may be raised to 2000 r in individual cases. It is always necessary, however, to follow-up the patient over a long period of time, for a temporary recovery does not exclude the possibility of the tumour being malignant.In severe cases without immediate positive reaction to x-ray therapy in small doses and in cases with severe pain and loss of vision, primary surgical therapy is to be recommended. Cases with little pain only can be treated with analgetics.

     

Experimentelle Untersuchungen über die Wirkung verschiedener Fette auf den Serumfettspiegel des Menschen

Zusammenfassung Bei gesunden Versuchspersonen werden die Serumlipoide nach Gabe von synthetischen und aus natürlichen Fetten gewonnenen reinen Triglyceriden und Triglyceridgemischen untersucht. 0,5 g Triolein pro Kilogramm Körpergewicht bewirken einen starken Anstieg der Neutralfette im Serum, der nach Angebot von Triglyceridgemischen aus nur mittellangen Fettsäuren (Tricaprylin, Tricaprin, Trilaurin) ausbleibt. Tristearin und Gemische von Tri-DiMono-Stereat in fester Form lassen die Serumlipoide nicht ansteigen, sondern sogar abfallen. Wenn man den Schmelzpunkt des Stereatgemisches durch Zusatz flüssiger Glyceride mittellanger Fettsäuren senkt, so wird die Resorption verbessert. Reines Äthyllinolat bewirkt eine deutliche alimentäre Lipämie.Natürliche Fette mit reichlichem Gehalt an mittelkettigen Fettsäureglyceriden (Cocosfett) lassen flachere Resorptionskurven im Serum entstehen als solche mit überwiegend langkettigen und einfach ungesättigten (Butter) und als solche mit einem großen Anteil an mehrfach ungesättigten Fettsäuren vom Typ des Leinöls.Dieses Verhalten kann durch den portalen Weg und durch die besonderen Stoffwechselbedingungen der mittelkettigen Fettsäuren im Gegensatz zu den auf dem Lymphweg transportierten langkettigen Fettsäuren erklärt werden.Man muß zwischen den steileren Resorptionskurven nach Butter und Leinöl und den flachen Kurven nach Cocosfett einerseits und der serumlipoidsenkenden Wirkung langfristiger Leinölgaben andererseits unterscheiden. Sowohl Butter als auch Cocosfett lassen die Serumlipoide nach langfristiger Darreichung nicht absinken, obwohl beide verschiedene Resorptionskurven zeigen.     

Effect of Heparin‐Induced Extracorporeal Low‐Density Lipoprotein Precipitation (HELP) Apheresis on Hepatitis C Plasma Virus Load

Abstract: Association of the hepatitis C virus (HCV) with apolipoprotein B containing lipoproteins has been suggested, and this led to the concept that the low‐density lipoprotein (LDL) receptor may also serve as a candidate receptor for HCV uptake into the liver. We have investigated whether heparin‐induced extracorporeal LDL precipitation (HELP) LDL apheresis treatment reduces HCV plasma load in 6 patients, all infected for more than 4 years with HCV and resistant against established anti‐HCV therapy. HELP apheresis treatment caused an HCV‐RNA decrease of 77.3% in mean. This decline was not correlated with LDL‐cholesterol reduction. HCV‐RNA was retained on the HELP filter as shown for 1 patient. The effect of RNA lowering was only transient due to the high turnover of HCV. However, HELP apheresis may open a window of opportunity for an immune‐modulating and antiviral therapy in the interval between two apheresis procedures in patients with high virus load.     

The methotrexate therapeutic response in rheumatoid arthritis

OBJECTIVE: Methotrexate (MTX) is used frequently as a disease modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA), and patients tend to continue taking this drug for longer periods than alternative single agents. The shape of the therapeutic response beyond one or 2 years, however, has not been fully studied. We examined the properties of the pure MTX "therapeutic segment," that period that begins with start of MTX and terminates when MTX is discontinued or another DMARD is added, by observational study. METHODS: We studied new MTX starts for the period 1988 through 1996 for 437 patients from a parent cohort of 4253 patients. Patients were drawn from 8 Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) data centers: 2 community based populations; 2 private rheumatological practices; 2 university referral practices; and 2 university clinics for underserved minority urban populations. Health Assessment Questionnaire (HAQ) Disability Index scores (0-3) were obtained prospectively each 6 months. RESULTS: At MTX start, patients had relatively long average disease duration of 16.7 years, and had moderately severe disability, with an initial HAQ mean disability score of 1.48. Over the 10 year period examined in the parent cohort of 4253 patients (and thus irrespective of therapy), the prevalence of MTX use rose from 19% to 45%, while mean HAQ disability declined from 1.34 to 1.11. This correspondence is consistent with an accrual of benefits from more frequent use of MTX and other DMARD over this period. The MTX therapeutic segment revealed a distinct shape. HAQ-Disability Index values began at 1.48 at baseline and declined to a maximal improvement of 1.23 at 30 months. This long period to maximum benefit may have been partly driven by a slow titration upward to an optimal dosage. After 42 months, disability for this population began to re-progress and reached 1.39 at 84 months, still below the pretreatment baseline. Re-progression to baseline was about 8 or more years. Cumulative disability averted with MTX treatment for this population was roughly 1.30 disability-unit-years. CONCLUSION: MTX treatment of RA in practice differs substantially from common perception and appears suboptimal by being too little, too late, and too long to treatment change. A modification of the "sawtooth strategy" in which the disease is "ratcheted down" by change of MTX therapy at 3 years or when re-progression has proceeded halfway to baseline, rather than waiting for return to baseline, is suggested by these data. Also suggested is the need for more rapid upward dosage titration and longer maintenance of an optimal or highest tolerated dosage. "Therapeutic segment" data provide insights into strategic approaches to management of RA since they allow estimation of population aggregate properties such as time to maximum benefit and the time to return to baseline.     

Platelet-derived growth factor — A growth factor with an expanding role in health and disease

Summary Platelet-derived growth factor (PDGF) is the principal mitogen for connective tissue-derived cells such as fibroblasts, smooth muscle cells, and glial cells. It is synthesized by a variety of cell types and the synthesis of PDGF and its receptors is tightly controlled. Accumulating evidence obtained in vitro and in vivo suggests that PDGF plays important roles in the pathogenesis of clinically important diseases such as atherogenesis and cancer. Moreover, PDGF is an important research tool to study the signal transmission pathway of growth factors and other hormones.Abbreviations PDGF platelet-derived growth factor Dedicated to Professor Wilhelm Doerr on the occasion of his 75th birthdaySupported by the Deutschen Forschungsgemeinschaft and the Forschungsrat Rauchen und Gesundheit     

Differences in the risk factor patterns for coronary heart disease in China,Japan, and Germany

Summary In Asia coronary heart disease mortality is almost 10 fold less frequent than in European countries. These findings attract interest to search for different risk factor patterns. From 1982 to 1985 epidemiologic surveys were carried out in China (n=2047), Japan (n=7580) and Germany (n=6052). Healthy, male subjects, aged 30 to 59 years were enrolled. The prevalence rate of hypertension for the Germans was 20% versus 18% for the Japanese, and 11% for the Chinese. About 69% of Chinese, 55% of Japanese, and 37% of Germans were smokers. About 66% of the Germans were overweight (BMI>25), 17% of the Japanese, and 11% of the Chinese. The highest risk group with cholesterol levels of >300 mg/dl included no Chinese subject, 0.1% of the Japanese, but 5% of the Germans. The lipoprotein profiles among the Japanese and the Chinese collectives typically showed antiatherosclerotic characteristics, whereas most Germans exhibited profiles which support development of atherosclerosis. About 36% of the participants from Germany showed 3 or more risk factors accumulated per person (Japan and China 5%). Multifactorial risk factor reduction for Germany is recommended.