Fulminating hyperlipidaemia.

A case is described of severe recurrent ischaemic heart disease associated with rapidly increasing and ultimately massive hyperlipidaemia. The case is discussed, with suggestions for management of similar problems.

Jejunal morphology in multiple sclerosis.

In a prospective survey jejunal biopsy samples from 11 patients with multiple sclerosis on normal diets were compared with those from controls matched for age and sex. Quantitative histology, morphometry, and electron microscopy showed no difference between the two groups. Since there was no evidence that gluten sensitivity plays a role in the aetiology of multiple sclerosis, the wide adoption of gluten exclusion by patients seems unjustified.

Comparison of fixed doses of chenodeoxycholic acid for gallstone dissolution.

96 patients with gallstones have been treated for up to four years with chenodeoxycholic acid in daily doses of 500, 750, or 1000 mg. None of the patients started on 500 mg daily showed complete gallstone dissolution. 8 out of 41 patients on 750 mg daily had complete dissolution of their radiolucent gallbladder stones after six or more months, and a further 4 showed partial dissolution.

Reversal of clofibrate-induced cholesterol oversaturation of bile with chenodeoxycholic acid.

Giving clofibrate 2 g daily to seven patients significantly increased the biliary cholesterol concentration while the proportion of bile acids fell. Five patients on established clofibrate treatment were given 750 mg of chenodeoxycholic acid (CDCA) daily for one month. Biliary lipid analysis after the CDCA treatment showed a significant fall in the proportion of cholesterol and a rise in that of bile acids.

Chenodeoxycholic acid therapy for hypertriglyceridaemia in men.

1 Ten consecutive patients with hypertriglyceridaemia who adhered to a low carbohydrate diet without complete control of serum triglycerides were started on chenodeoxycholic acid 750 mg daily and followed monthly for 6 months. Nine of these patients were then followed for a further month on placebo capsules and thereafter monthly for a further 6 months on clofibrate 2 g daily. 2 The mean serum triglyceride level fell by 36% after dietary treatment alone (P less than 0.

Serum bile acids in patients with hyperlipidaemia.

Individual serum bile acids were analysed by an improved gas liquid chromatography method in 12 patients with primary hyperlipidaemia. Total serum bile acid concentrations were raised in 10 subjects. Ursodeoxycholic acid was found in all 12 patients.

Severe pulmonary disease and hyperviscosity in macroglobulinaemia.

A case of Waldenstrom's macroglobulinaemia with various clinical manifestations of the condition is presented. Hyperviscosity and respiratory complications are discussed with a brief review of the literature.

Effect of prolonged feeding with chenodeoxycholic acid on bile in patients with and without gallstones.

Nineteen patients who received chenodeoxycholic acid 750 mg/day for six months had duodenal bile aspirated before and after treatment. In five patients with hypertriglyceridaemia but no gallstones cholesterol saturation was reversed in every case, the mean cholesterol saturation index (SI +/- standard deviation) changing from 1-38 +/- 0-31 to 0-68 +/- 0-06 (P less than 0-005). In 14 patients with gallstones there was also an improvement in bile cholesterol content, but this was not sufficient to produce mean unsaturation, saturation index changing from 1-55 +/- 0-52 to 1-13 +/- 0-43 (P less than 0-05).

Effect of gallstone-dissolution therapy on human liver structure.

To assess potential toxic effects liver biopsies were performed before and after 6-8 months therapy with chenodeoxycholic acid (CDCA), 750 mg daily, in 6 patients with gallbladder stones. Minor fatty change and lipofuscin were seen prior to therapy, which tended to increase afterwards. Otherwise there was no consistent change on light microscopy.

Cotrimoxazole and folate metabolism.

Cotrimoxazole 4 tablets daily (1 tablet = trimethoprim 80 mg and sulphamethoxzole 400 mg) was given for a period of six to fourteen days to 13 inpatients, and serum-folate levels were measured before and one day after the course of treatment. The results were compared with those from 8 patients not receiving antibacterial therapy, tested on admission and one week later. Two assay techniques were used, one employing Lactobacillus casei and the other 125I-labelled folate isotope dilution.