Apolipoprotein E phenotype and lipoprotein(a) in familial hypercholesterolaemia: implication for lipoprotein(a) metabolism.

The mechanisms regulating plasma levels of lipoprotein(a) [Lp(a)] are largely unknown. A two- to three-fold increase in Lp(a) levels in patients with familial hypercholesterolaemia (FH) has implied that LDL receptor activity may be an important factor in determining plasma Lp(a) levels, as it is in determining low-density lipoprotein (LDL) cholesterol concentration. Common apolipoprotein E (apoE) variants also affect plasma LDL cholesterol levels.

Art and literature in the anatomy of Charles Bell.

The artistic gifts of Sir Charles Bell (1774-1842) directed the course of his life's work. There is a fairly extensive literature on the discoveries of Bell in neurology and myology but comparatively poorly documented are the ways in which Bell exploited his aesthetic talents and erudition to communicate his findings to others. This study attempted to answer the question; how did Bell use art and literature to teach anatomy? The problem is all the more interesting because, in keeping with the spirit of education and improvement of the day, Charles Bell did not limit himself to addressing the medical profession but spoke to a wider public, dwelling on artists in particular.

Cutaneous nerve fibre depletion in vibration white finger.

Vibration white finger or hand-arm vibration syndrome is the episodic blanching of the fingers in response to cold occurring in those who work with hand held vibrating tools. Clinically the condition differs from primary Raynaud's phenomenon as persistent paraesthesiae and pain are common in the hands and arms and these occur independently from the 'white attacks'. Symptoms can become severe enough to warrant a change of occupation.

Circulating and synovial fluid hyaluronan levels. Effects of intraarticular corticosteroid on the concentration and the rate of turnover.

Objective: To assess the effect of intraarticular (IA) corticosteroid on hyaluronan (HA) concentrations in synovial fluid (SF) and serum and the clearance of 131I-labeled albumin from the joints of patients with rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS).

Methods: SF and serum were collected before and 2 weeks and 2 months after IA steroid injection. The HA concentration was assessed using an enzyme-linked immunosorbent assay and 131I-albumin clearance from joints was assessed using an external gamma counter.

Comparison of lipid-lowering effects of low-dose fluvastatin and conventional-dose gemfibrozil in patients with primary hypercholesterolemia.

A total of 123 patients with primary hypercholesterolemia were randomized on a 2:1 ratio to receive either fluvastatin at 20 mg once daily at night (n = 82) or gemfibrozil at 600 mg twice daily (n = 41) in a double-blind, double-dummy comparison of the effects on plasma lipid parameters and tolerability over 8 weeks. All patients had either low-density lipoprotein cholesterol (LDL-C) concentrations > or = 160 mg/dL (4.1 mmol/L) in association with definite coronary artery disease (CAD) or > or = 2 risk factors, or LDL-C > or = 190 mg/dL (4.

Germ cell failure and Leydig cell insufficiency in post-pubertal males after autologous bone marrow transplantation with BEAM for lymphoma.

Thirteen post-pubertal male patients aged 17-25 years were assessed for pituitary-gonadal function 0-3 months prior to and 2-3 months post-bone marrow transplantation for haematological malignancy. All patients had multiagent cytotoxic treatment prior to transplantation and 30% were found to have germ cell dysfunction with abnormal semen parameters before high-dose therapy indicating damage to the germinal epithelium. They also had evidence of reduced Leydig cell reserve even before transplantation.

Prospective study of pituitary-gonadal function to evaluate short-term effects of ablative chemotherapy or total body irradiation with autologous or allogenic marrow transplantation in post-menarcheal female patients.

Pituitary-gonadal (P-G) function was evaluated 0-3 months before and 3-4 months after bone marrow transplantation (BMT) in 15 post-menarcheal females aged 17-30 (21.6 +/- 0.34) years with haematological malignancies.

Tissue and cellular patterning of the musculature in chick wings.

Development of the musculature involves generation of a precise number of individual muscles arranged in appropriate locations, each with the correct cellular patterning. To find out the rules that govern muscle number and arrangement, the forearm musculature of chick wing buds was analysed following grafts of the polarizing region or application of retinoic acid. Muscle patterns appear symmetrical with 'posterior' muscles now forming in the anterior part of the wing.

Methods for epidemiological surveys of ethnic minority groups.

OBJECTIVE--Research into the health of minority ethnic groups is often restricted by methodological difficulties. These include the lack of accurate population denominators, the choice of an appropriate sampling frame, correctly assigning ethnic group, and biases in techniques used for sampling and investigation. This article reviews the available sources or mortality and morbidity data, and assesses their uses and limitations for research involving ethnic minority groups.

Chemotherapy dose intensity in small cell lung cancer.

The evidence that increasing the dose intensity of chemotherapy in SCLC improves survival is reviewed. The paucity of randomized trials, the failure to report delivered dose and the methodological problems in presenting dose intensity data, mean that at present no firm conclusions can be drawn about potential survival benefit with increasing intensity of treatment. It seems possible that increases in survival can be obtained with increased intensity of chemotherapy but the degree is likely to be small and the size of randomised trials must therefore be large.

Optimization of the bearing surface geometry of total knees.

Various design criteria were examined in combination to find the ideal geometry for a condylar knee replacement. The criteria were the contact stresses on the plastic, femoral-tibial size interchangeability, patella lever arm, laxity and stability and the amount of bone resection required. The variables were the radii of curvature of the femoral and tibial bearing surfaces in the sagittal and frontal planes.

Fundamental bases of combined therapy in lung cancer: cell resistance to chemotherapy and radiotherapy.

This overview briefly examines the mechanisms of drug resistance in lung cancer, including multidrug resistance and its atypical phenotypes, the role of cytoplasmic protectors such as glutathione, and resistance at the level of the DNA through topoisomerases, gene amplification or mutation, and DNA repair. Understanding of radioresistance is less advanced, but resistance may arise through limitation of the amount of DNA damage inflicted or by its subsequent modification by intracellular protectors or DNA repair. The mechanisms of radioresistance are generally distinct from those of chemoresistance providing a rationale for the use of combined modality therapy.

A prospective study of the psychological impact on patients with a first episode of genital herpes.

Objectives: To assess the psychological impact of first episode of genital herpes, and to determine whether this changes over time.

Setting And Subjects: The Departments of Genitourinary Medicine (GUM), and Dermatology, Middlesex Hospital London. The study group consisted of patients attending the department of GUM with a clinically proven first episode of genital herpes.

Serum macrophage colony-stimulating factor (M-CSF) levels correlate with clinical response to interferon-alpha in patients with early-stage B-CLL.

Interferon-alpha (IFN-alpha) reduces peripheral lymphocyte counts in B-CLL (CLL). In eight patients with stage 0 CLL on IFN-alpha therapy, peripheral lymphocyte counts fell to 61.7 +/- 19.

Cigarette smoking as a potential cause of cervical cancer: has confounding been controlled?

It is widely believed that some sexually transmitted pathogen plays a key role in the aetiology of cervical cancer. However, although certain human papilloma viruses are strongly implicated, the pathogen responsible and its mechanism of action remain to be finally characterized. The correlation between cigarette smoking and sexual activity that exists in most cultures therefore makes evaluation of the potential additional role of smoking difficult, due to confounding with the presence of the aetiological pathogen.

HMPAO SPECT in Parkinson's disease before and after levodopa: correlation with dopaminergic responsiveness.

Regional cerebral perfusion was evaluated by SPECT with technetium 99m hexamethylpropyleneamine oxime (99mTc HMPAO) as a tracer in 21 patients presenting with Parkinson's disease and in 11 normal controls. In the parkinsonian patients, scans were performed both off treatment, and after levodopa, and clinical dopaminergic responsiveness was evaluated. Uptake of HMPAO by the basal ganglia was significantly decreased in the parkinsonian subjects, compared with normal controls.

Serial MRI of the brain in asymptomatic patients infected with HIV: results from the UCMSM/Medical Research Council neurology cohort.

Seventy-six homosexual or bisexual men underwent two cranial MRI studies at a mean interval of 13 months; 23 were HIV seronegative, 41 seropositive but asymptomatic (Center for Disease Control (CDC) groups II/III), and 12 had AIDS related complex (ARC)/AIDS (CDC group IV). Agreement between two neuroradiologists was rated as very good for assessment of enlargement of ventricles and good for widening of cerebral sulci and the presence of focal lesions. For assessment of serial studies, the agreement was moderate.

Hybridization of the variable number of tandem repeat core oligonucleotide GNNGTGGG to 350 cosmids from chromosome 7.

An efficient method using short oligonucleotides is described for the isolation of minisatellite markers of the type variable number of tandem repeats (VNTR). It is used to screen 350 cosmids from chromosome 7 for the presence of such potentially polymorphic DNA segments. From the number of hybridization signals to chromosome 7 cosmids, I estimate the human genome to have at least about 15000 VNTR loci containing minisatellite core sequences, which is well above previous estimates.

Are bereaved family members a valid proxy for a patient's assessment of dying?

Objective: To compare assessments made retrospectively by bereaved family members (or the nearest carer to the patient) with assessments made before death by palliative staff and, where available, by patients themselves or the family member.

Methods: SETTING--two palliative care support teams. ASSESSMENTS--were recorded prospectively by team staff, patients and their family members for consecutive patients referred, and then were recorded retrospectively by family members during interview seven months after bereavement.

Porokeratosis of Mibelli on the penis, scrotum and natal cleft.

Genital porokeratosis of Mibelli is rare. We report a patient with lesions affecting the penis, scrotum and natal cleft and discuss the aetiology, clinical presentation and treatment of the condition.

Zonal distribution of chondroitin-4-sulphate/dermatan sulphate and chondroitin-6-sulphate in normal and diseased human synovium.

Objectives: Chondroitin sulphate is the major sulphated glycosaminoglycan present in the extracellular matrix of soft connective tissues and the aim of this study was to investigate the distribution of chondroitin sulphate species in normal and diseased synovium.

Methods: Distribution of chondroitin-4-sulphate/dermatan sulphate (Ch4S/DS) and chondroitin-6-sulphate in normal (n = 6), osteoarthritic (n = 4) and rheumatoid (n = 10) synovium was determined using an immunoperoxidase technique and specific monoclonal antibodies to chondroitinase ABC-digested preparations.

Results: Ch4S/DS was expressed throughout the interstitium of all tissues and was also present on blood vessels in rheumatoid samples only.

Maternal plasma progesterone levels fall after rectal administration of estriol.

Maternal plasma unconjugated estriol (E3), progesterone (P), and estradiol (E2) levels were measured at 30-min intervals for 6 h after the rectal administration of a 100-mg E3 or placebo suppository to 28 pregnant women at term. Mean plasma unconjugated E3 levels showed a sustained rise approximately 50% above baseline levels 2 h after rectal E3 administration (P < 0.003).

Oligonucleotides as short as 7-mers can be used for PCR amplification.

Amplification of DNA sequences using the polymerase chain reaction (PCR) requires as primers two oligonucleotides, which are carefully designed for length and G/C content. Such primers are generally between 18 and 30 bases long so that the primer sequences can amplify a unique sequence in the target genome; they should possess a minimal degree of secondary structure. We have tested the minimum length of G/C-rich and palindromic oligonucleotides to be used as primers in PCR.