Change in very low-, low-, and high-density lipoproteins during lipid lowering (bezafibrate) therapy: studies in type IIA and type IIb hyperlipoproteinaemia

The effects of lipid lowering therapy (bezafibrate) on plasma lipoproteins was investigated in twelve patients with familial hypercholesterolaemia (type IIA) and eight with familial combined hyperlipidaemia (type IIB). Bezafibrate caused a decrease of plasma cholesterol, plasma triglycerides, plasma apolipoprotein B, VLDL cholesterol and LDL cholesterol and an increase of HDL cholesterol. Post-heparin plasma lipoprotein and hepatic lipase activities increased in both groups (significant only in type IIB). Lipoprotein composition showed the following changes: Increased protein and phospholipids and decreased triglycerides and cholesteryl esters in VLDL. Decreased protein and triglycerides and increased free and esterified cholesterol in LDL. Decreased triglycerides and increased phospholipids in HDL. Cholesteryl ester to protein ratios decreased in VLDL and increased in LDL. The hydrated density of LDL (both groups) and of HDL3 (type IIB) decreased following bezafibrate therapy. These changes were in general similar to those observed in hypertriglyceridaemic patients and could be ascribed, at least in part, to the increase of plasma lipase activities and the decrease of lipid transfer reactions. Comparing the present data with that previously reported, it was found that bezafibrate caused decreased LDL cholesterol in types IIA and IIB but increased levels in type IV. This change was correlated with the initial plasma triglycerides (r = 0.74, P less than 0.0001) and initial plasma LDL cholesterol (r = 0.66, P less than 0.001). It is concluded that varied response of LDL to therapy reflects a complex interaction of metabolic events, including changing rates of VLDL conversion to LDL, lipoprotein compositional changes and effects of therapy on LDL degradation rates.     

Dominance of memory over naive T cells in contact dermatitis is due to differential tissue immigration

CD4+ T cells include a naive (CD4-, CD45RO-, CD29-, CD45RA+) as well as a memory subpopulation (CD4+, CD45RO+, CD29+, CD45RA-). These subpopulations represent different stages in T-cell development and function. Recently, it has been shown that inflammatory and neoplastic CD4+ T-cell infiltrates are dominated by the memory subpopulation, whereas both subpopulations are about the same size in the peripheral blood. This was thought to be the result of in situ maturation of naive into memory T cells. We analysed early positive patch-test reactions 1-2 days after antigen challenge and found that most of the CD4+ T cells that had freshly immigrated into the tissue carried the memory phenotype. Their preferential migration may be mediated by at least five adhesion molecules expressed on their cell surface. This observation has important pathogenetic implications, since memory T cells can be rapidly activated by antigens and secrete a wide variety of pro-inflammatory cytokines.     

CLOCK DRAWING TEST IN ELDERLY SCHIZOPHRENIA PATIENTS

Objective. Clock drawing has been studied in Alzheimer's disease but not in elderly schizophrenics. We examined clock drawing ability in elderly schizophrenia patients and sought possible correlations with demographic, clinical and cognitive variables. Design. Retrospective analysis of the clock drawing item from the Cambridge Cognitive Examination (CAMCOG) presented to three independent raters. Setting. Long-stay ‘open’ departments of a public psychiatric hospital in Israel. Patients. Thirty-one physically well psychiatric inpatients suffering from schizophrenia (DSM-III-R, APA), between ages 60 and 76 years. Measures. The Clock Drawing Interpretation Scale (CDIS). Results. The mean CDIS score was 14.4 (out of 20), and 61–84%of patients scored beneath the normal range (>18). Interrater reliability was high (0.91–0.96). A moderate but significant correlation was found between CDIS and duration of illness as well as total scores on the Manchester Scale, the CAMCOG and the Mini-Mental State Examination, but not with the other variables studied. Conclusions. Clock drawing skills of a significant portion of long-term institutionalized elderly schizophrenics are impaired. When this test is used as a screening device for Alzheimer's disease in these patients, the results should be interpreted cautiously. Clock drawing abilities in these patients seem to be related to cognitive and non-cognitive (psychiatric state) factors, as well as to illness duration.     

The use of phospholipid liposomes for lithium administration. Polydipsic effect and tissue distribution of lithium

Administration of lithium entrapped in phospholipid liposomes increased the lithium-induced polydipsia, but did not accelerate the onset of this effect. It also resulted in a larger accumulation of lithium in the liver, kidney and spleen, but not in the brain. The time course of polydipsia suggests that it depends on the intracellular lithium concentration. However, the rate of development of this effect depends on some additional factor.     

Carotid Sinus Hypersensitivity: Diagnosis of Vasodepressor Type in the Presence of Cardioinhibitory Type

The diagnosis of carotid sinus syncope may sometimes be difficult because its symptoms are not specific, especially in the older age group where carotid sinus hypersensitivity and syncope are not uncommon events. Of major diagnostic importance is the screening of the vasodepressor type of carotid sinus syncope in the presence of the cardioinhihitory type, as this diagnosis has important therapeutic applications. This work is based on the electrophysiological studies performed on seven men with a mean age of 61.9 years who had syncope of unknown cause and hypersensitive carotid sinus reflex. The studies revealed no evidence of sinus node dysfunction or high degree atrioventricular block that would explain the neurological symptoms. The studies also included carotid sinus stimulation with simultaneous interarterial pressure recordings with and without atrial or A-V sequential pacing. The pacing assured the maintenance of normal heart rate during carotid sinus stimulation. The results of these studies revealed that five patients suffered from cardioinhibitory type and two from a combined form of cardioinhibitory and vasodepressor type (mixed form) of carotid sinus syncope. A permanent cardiac pacemaker was implanted in the five patients with the isolated cardioinhibitory type and in one patient with the mixed type of carotid sinus syncope.