Changes in very low density lipoproteins with cholesterol loading in man

We have studied the effects of cholesterol loading in man, seeking changes in VLDL that may define a population of particles that resemble the atherogenic β-VLDL in experimental animals. Comparisons were made in 6 men during two diets, containing either 200 mg or 1700 mg cholesterol daily. Although the total plasma cholesterol did not rise significantly over 4 wk of cholesterol loading (mean ± SD 178 ± 41 to 194 ± 48 mg/dl), distinct changes in lipoprotein composition occurred; (1) HDL cholesterol rose significantly (34 ± 4 to 41 ± 5) and plasma apoprotein Al rose from 118 ± 10 to 129 ± 9 mg/dl, (2) Within VLDL, the proportion of apoproteins E:C rose from 0.18 to 0.32 (p < 0.005), though the apoprotein E concentration did not change, (3) Within VLDL, the ratio of cholesteryl esters:triglyceride rose, (4) Within VLDL (Sf 20–400) a population of particles that bound to heparin on heparin-sepharose columns increased threefold; since these particles were richer in apoprotein E and in cholesteryl ester than were VLDL not bound to heparin, we conclude that cholesterol loading leads to an increase in smaller VLDL particles, possibly partly catabolized VLDL or independently secreted IDL, that resemble findings in cholesterol fed animals, and (5) Transport kinetics of apoprotein B in VLDL studied in four subjects did not show a rise in production but this does not rule out increased secretion of a cholesteryl ester, apoprotein E enriched subpopulation of VLDL.     

The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis

Four thousand wrist x-ray films were reviewed to establish the pattern of sequential changes in degenerative arthritis of the wrist. After eliminating all other arthritides, we studied 210 cases of degenerative arthritis. The most common pattern (57%) was arthritis between the scaphoid, lunate, and radius; 27% of cases occurred between the scaphoid, trapezium, and trapezoid; a combination of these two patterns occurred in 15%. Twenty operations were performed on 19 patients with the scapholunate advanced collapse pattern. Eighteen of 19 patients had less pain postoperatively and none required pain medication. Flexion-extension and radial-ulnar deviation motions showed considerable improvement after the operation.     

Diagnosis of carotid stenosis by bruit spectral analysis

Bruit spectral analysis provides an improved noninvasive method of quantifying the severity of carotid stenosis, and the method of Lees estimates the residual luminal diameter. Although the analysis required is complex, the test can be easily performed using the Spectraview, a microcomputer-based device which records and processes the sound information. The present study evaluated 44 cervical bruits in patients and found that in 84 percent of the vessels the estimated luminal size was within 1 mm of the angiographic lumen. Although substantial experience is required to obtain the maximum diagnostic accuracy, work with the technique during 18 months indicates that it provides more information from arterial bruits than traditional phonoangiography.     

Position artifacts in occlusive impedance phlebography (plethysmography)

The accuracy of occlusive impedance phlebography (IPG) depends on recognition of the artifacts that produce false-positive results. Fifty per cent of a series of studies of patients with normal legs showed abnormal results when the recording was made with the leg held straight. We therefore recommend that the patient's leg position be carefully monitored when an IPG test is being administered.     

Late sequelae of deep venous thrombosis. Diagnostic and therapeutic considerations

The efficacy of heparin, sodium warfarin, and elastic stockings in preventing the late leg sequelae of deep venous thrombosis was evaluated by reexamining 15 patients with previous acute deep venous thrombosis so treated. All 5 patients with iliocommon femoral disease and only 5 of 10 patients with distal disease had evidence of postphlebitic syndrome. Venous Doppler and strain gauge plethysmography confirmed these clinical findings. The most striking and consistent laboratory abnormalities were in the patients with proximal disease. Treatment of acute deep venous thrombosis by traditional means does not prevent the clinical and laboratory late leg sequelae. In light of these findings, serious investigation of new therapeutic modalities is strongly suggested.     

Emotional control and autonomic arousal in breast cancer patients

Thirty breast cancer patients and 27 “healthy” controls were compared for differences in personality, reported emotional state and autonomic responses occurring under conditions of acute experimental stress. The data indicated that breast cancer patients were more likely than a control group to report a tendency to control emotional reactions, particularly anger, and to respond to stress using a repressive coping style. Emotional state reported at different points throughout the procedure suggested that the breast cancer group experienced more anxiety and disturbance but were more inclined to inhibit their reaction. There were no differences between the groups on autonomic measures but within the breast cancer group increased electrodermal activity was significantly associated with a tendency to respond to stress using a repressive coping style. The results are discussed in relation to psychobiological models of cancer.     

Clinical staging of cancer of the head and neck: A new “new” system

A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.     

Increased catabolism of high density lipoprotein in alcoholic hepatitis

The kinetics of high density lipoprotein apoprotein A-I were determined in three subjects with severe alcoholic hepatitis. Lipoprotein was obtained from three healthy subjects, radioiodinated, and injected into the patients and the donors. The catabolic rate of A-I was two to four times higher in the patients compared to a group of 18 control subjects studied previously. In the patients only, about 20% of the radiolabeled apoproteins rapidly appeared in the lipoprotein-poor fraction of plasma, which also contained substantial amounts of unlabeled A-I. The findings show that the reduced concentration of A-I in alcoholic hepatitis (less than half-normal), is due not to diminished synthesis (synthesis was normal) but to rapid degradation. This may reflect disruption of abnormal high density lipoproteins due to lack of cofactors.     

Topical Cardiac Cooling by Recirculation: Comparison of a Closed System Using a Cooling Pad with an Open System Using a Topical Spray

Topical cardiac cooling plays an important part in maintaining myocardial hypothermia during cardiac operations under hypothermic cardioplegic arrest. We have compared two systems of topical cooling in which the cooling fluid is recirculated. In one system the cold fluid circulates through a sealed plastic cooling pad wrapped around the heart; in the other it is sprayed over the surface of the heart.In dogs undergoing 60 minutes of hypothermic cardioplegic arrest, the cooling pad was ineffective: it did not adequately cool the anterior left ventricular wall or the interventricular septum. Under the same conditions, the spray system produced myocardial temperatures 6° to 12°C lower than the cooling pad system. In limited clinical tests, the cooling pad was unable to sustain overall myocardial hypothermia and there was difficulty in maintaining contact between the heart and the pad during coronary operations. Since the topical spray can maintain profound global myocardial hypothermia regardless of the position of the heart, we conclude that it is superior to the cooling pad system.     

Posttraumatic sesamoid arthritis of the metacarpophalangeal joint of the thumb

The articular interface between the radial sesamoid and the radial condyle of the metacarpal head, which is the radial subsesamoid joint, is the most frequently involved area of abnormality in the metacarpophalangeal joint complex. More than 85% of all adult cadavers demonstrate degenerative arthritis of the radial subsesamoid joint. Confusing this condition with degenerative arthritis of the metacarpophalangeal joint may lead to unnecessary joint fusions. The predisposition of the radial subsesamoid to degenerative arthritis is related to the asymmetry of the palmar condyles of the metacarpal. The ulnar sesamoid has a flatter and broader condyle compared with the radial sesamoid, which rides on a high, narrow ridge. Thirty-six patients with symptomatic sesamoiditis have been treated by sesamoidectomy since 1978. Twenty-one of these patients were available for follow-up examination between 1 and 5 years after surgery, and 19 had relief of proximal thumb pain after sesamoidectomy.