Four DNA polymorphisms in the LDL-receptor gene and their use in diagnosis of familial hypercholesterolemia

To examine the potential usefulness of restriction fragment length polymorphisms (RFLPs) for diagnosis of familial hypercholesterolemia (FH), we determined the genotype of FH patients and their relatives for the Apa1I, NcoI, PvuII and StuI RFLP of the LDL-receptor gene in a sample of German patients attending the Lipid Clinic in Munich. There was no significant difference in the relative allele frequency between the group of FH patients and controls for any of the four polymorphisms. Using linkage analysis, we could determine the four-RFLP haplotypes of 39 defective and 90 normal LDL-receptor genes in 38 FH families. In our sample, defective LDL-receptor genes occur on 6 different chromosomes determined by the four RFLPs. This suggests that at least 6 different genetic defects may cause FH in this sample. RFLPs of the LDL-receptor gene cannot be used to detect FH in individuals; however, appropriate diagnosis can be carried out in more than 90% of families using linkage analysis and these RFLPs.

Psychological and physical variables as predictors of coping strategies

26 women and 17 men between the ages of 26 and 62 yr. of age and diagnosed as having chronic illnesses were administered four questionnaires to assess physical and psychological variables and coping strategies: the Sickness Impact Profile, the Time Reference Inventory, and the Multidimensional Health Locus of Control. The Jaloweic Coping Scale assessed coping strategies. Canonical correlation indicated a single-factor link (Wilks' lambda) between scores on the first 3 tests, and the subscales of the coping scale. A significant but small correlation of .31 between the Multidimensional Health Locus of Control subscale, Powerful Others, and the coping subscale of Emotion-focused strategies was observed, that with the subscale Chance and the coping subscale confrontive strategies was negative. A second canonical correlation deleting the Time Reference Inventory score of age extension and including the three Sickness Impact Profile subscales was significant and positive for the Composite score and the subscale Palliative of the Jaloweic Coping Scale. Such data suggest that individuals who have a locus of control orientation of Powerful Others respond to chronic illness with emotionally based behaviors. In addition, chronically ill individuals who are physically dysfunctional tend to respond with palliative coping strategies.

Unusual but reversible hepatic lesions following long-term treatment with pyridylcarbinol for familial hypercholesterolemia

We report two cases of unusual hepatic lesions following years of monotherapy with pyridylcarbinol (timespan) in a daily dose of 1.35 to 1.5 g for familial hypercholesterolemia. Mild elevations of liver enzymes correlated to a large tumor-like mass in the gallbladder region in one case and nodular changes in the whole liver (diagnosed by ultrasound) similar to metastatic lesions. After discontinuation of pyridylcarbinol the changes in the liver regressed markedly in both cases.

Changes of atherosclerosis of the carotid arteries due to severe familial hypercholesterolemia following long-term plasmapheresis, assessed by duplex scan

Three males, aged 15, 22, and 25 years, have been followed for Familial hypercholesterolemia (FH) from 1968 and 1976 onward, being treated by plasmapheresis for 2 to 5 years continuously, at 1- to 2-week intervals. Whereas two patients have been continuously treated to date, the third discontinued plasma exchange after 4 years and has been reevaluated 6 years later. Discontinuation of plasma exchange led to progression of atherosclerosis of the carotid arteries documented by duplex scan, whereas one patient exhibited marked regression of former impressive soft plaque-formation and one patient showed no significant change. Two-dimensional computer-analysis suggested a reduction of plaque mass of up to 45% in one patient.

Atherosclerosis of the carotid arteries in young patients with familial hypercholesterolemia

Patients with heterozygous and homozygous Familial Hypercholesterolemia exhibit a high incidence of premature coronary heart disease, presumably due to atheromatous plaque-formation in the coronary arteries. Clinical symptoms develop when the disease has progressed to more severe stages of atherosclerosis. Aim of our study was to visualize and document early atheromatous lesions in the carotid arteries of asymptomatic patients with familial hypercholesterolemia under 30 years of age by Duplex-scan. Of 44 patients, 70% had detectable carotid plaques, while only 12% of the controls were affected. All patients with severe carotid disease had serum cholesterol levels above 350 mg/dl. In the age group 2-20 years, 66% of the patients exhibited plaques. Only 6% of the FH patients 21-30 years had normal carotid arteries. We conclude that the process of atheromatous plaque formation in patients with FH starts early in life, severity of atherosclerosis being a function of both extent and duration of hypercholesterolemia. Duplex-scan examination of the carotid arteries is efficient and precise non-invasive method suitable to visualize this process and, by measuring regression, monitor the efficacy of therapeutic measures.

Alkylating cytostatic treatment in renal amyloidosis secondary to rheumatic disease

Fourteen consecutive patients with chronic inflammatory rheumatic disease and reactive renal amyloidosis were treated with alkylating cytostatics in 22 separate periods varying in duration between six and 30 months. Chlorambucil alone was given in 14 treatment periods, cyclophosphamide alone in six, and both alternately in two. The dosage was adjusted to attain a major suppression of the rheumatic inflammation and a blood lymphocyte level below 1.0 X 10(9)/l. Renal function improved in 12 treatment periods, renal deterioration was arrested in three periods, and in another four periods the rate of functional decline slowed down. In the remaining three treatment periods, associated with further deterioration in renal function, treatment was inadequate owing to blood dyscrasia and failure to control hypertension. Glomerular filtration rate (GFR) was followed more closely in 10 treatment periods, in all of which the falling trend was arrested or reduced. The survival rate at five years was 93%. Three patients who dropped out of the treatment programme are so far the only ones not still alive. Nine are still being followed up after 6-17 years, and the other two remaining live patients have had renal transplants for five years.

'Ancestral' neural mechanisms of electrolocation suggest a substrate for the evolution of the jamming avoidance response

The genus Sternopygus, believed to reflect ancestral traits of gymnotiform electric fish, is closely related to the more 'modern' genus Eigenmannia (Mago-Leccia 1978; Fink and Fink 1981). Sternopygus is the only known genus of electric fish that does not perform a jamming avoidance response (JAR) to minimize the potentially detrimental effects of signal interference between discharging neighbors (Bullock et al. 1972, 1975), and its ability to electrolocate objects is rather immune to jamming (Matsubara and Heiligenberg 1978). By studying the responses of midbrain neurons to stimulus regimes effective in eliciting the JAR in Eigenmannia, we found that Sternopygus has neurons capable of discriminating the sign of the difference frequency between interfering electric organ discharges (EODs). These 'sign-selective' neurons, which are believed to be important elements in the control of the JAR in Eigenmannia, may, therefore, fulfill a more general function in the detection of moving objects and conspecifics but could potentially be assembled for the evolution of a JAR in Sternopygus. The relative immunity to jamming in this genus may result, in part, from a stronger reliance upon the ampullary electrosensory system which operates in the DC and low-frequency range, outside the EOD spectrum of these fish.

Atherosclerosis of the carotid arteries documented by duplex scan as a predictor of coronary artery disease in familial hyperlipidemias

The degree of atherosclerotic plaques in the carotid arteries was evaluated in 85 patients with familial hypercholesterolemia and in 43 patients with familial combined hyperlipidemia by means of Duplex scan which recognizes early atherosclerosis. In patients older than 40 years carotid atherosclerosis of moderate degree was associated with coronary heart disease in 90% of cases. The extent of elevated cholesterol, age, cigarette smoking, and hypertension determined the degree of carotid atherosclerosis.

Factors relating to hip joint arthritis following three childhood diseases--juvenile rheumatoid arthritis, Perthes disease, and postreduction avascular necrosis in congenital hip dislocation

This article discusses factors that relate to the prognosis for development of hip joint arthritis following juvenile rheumatoid arthritis (JRA), Perthes disease, and postreduction avascular necrosis in congenital hip dislocation (CDH). In JRA, the integrity of the articular cartilage determines prognosis. In Perthes disease, prognosis is strictly related to the shape of the hip. In postreduction avascular necrosis in CDH, half the patients have a prognosis primarily related to hip joint shape, and half have a prognosis apparently more related to the integrity of the articular cartilage.

Predicting the performance of daily activities of patients with chronic lung disease

40 men and 60 women between the ages of 40 and 59 yr. of age and having the diagnosis of chronic obstructive lung disease as measured by Fev1 values of less than 70% predicted pulmonary function were administered an outcome measure of functional ability, the Sickness Impact Profile. A prediction equation for functional ability, the variables of sex, socioeconomic status, respiratory impairment, and self-reporting of symptoms for analysis. In the two-variable model socioeconomic status and self-reporting of breathing difficulty contributed to 28% of the total variability in functional ability scores. In the three-variable model, adding the third independent variable of respiratory impairment (Fev1) did not significantly increase the explained variability in the outcome measure.

Regression of valvular aortic stenosis due to homozygous familial hypercholesterolemia following plasmapheresis

A 39-year-old male with homozygous familial hypercholesterolemia confirmed by tissue culture suffered from mild aortic insufficiency and valvular stenosis with a gradient of 20 mm Hg across the aortic valve. Plasmapheresis carried out every 2 weeks for 4 years resulted in a marked reduction in the serum cholesterol level and in a regression of the valvular stenosis, as shown by echocardiography and by left heart catheter.

Effect of plasma exchange with and without concomitant drug treatment on lipids and lipoproteins in patients with familial hypercholesterolemia confirmed by tissue culture

Repeated plasma exchange is an effective treatment for young patients with familial hypercholesterolemia. We treated 2 homozygous and 1 heterozygous patient with very high cholesterol levels with continuous plasma exchange using human albumin solution as exchange medium. The treatment was repeated every 2 weeks in 2 patients and weekly in the third. Treatment periods of plasma exchange alone and of plasma exchange with concomitant drug therapy were compared. For drug treatment beta-pyridylcarbinol, the alcohol corresponding to nicotinic acid (0.9 g/day equivalent to 3 g of nicotinic acid) and cholestyramine (16 g/day) were used. Plasma exchange alone resulted in a decrease of all lipids by 55% and of apolipoproteins by 50-60% as compared to the plasma levels before exchange. Subsequently all lipoproteins rose again to reach pre-exchange levels within about 2 weeks. There was no difference between the homozygous and the heterozygous patients. Beta-pyridylcarbinol or cholestyramine given concomitantly did not alter the post-exchange increase of total, LDL, HDL cholesterol nor of the corresponding apolipoproteins except of apolipoprotein B.

The role of fluid hydrostatic pressure in bone-implant interface load transfer

Permeability of the soft tissue-bone system surrounding artificial joints fixed in cancellous bone was measured in four adult dogs after implants had been in place 2 months. Fluid was forced through a cavity formed by removal of the implant, the cavity was capped with a stopper to allow for pressure generation. Surface permeability of the 2-month-old implant cavity was 45 times less than the permeability of freshly drilled holes in cancellous bone. A mathematical model of a rigid implant resting on a biphasic solid-fluid layer showed the fluid carried 90% of the load when the implant cavity permeability was assumed, but only 27% when the freshly drilled permeability was used. The results suggest caution in interpreting finite-element models with bonded interfaces and suggest a possible role of the fluid in biological response at the interface.

Computer programs for handling nucleic acid sequences

Programs have been developed that will accurately display restriction enzyme maps, open translational reading frames and the results of specific searches on a high resolution graphics terminal (Retrographics VT640). Many of our earlier programs have been upgraded to allow online access to GENBANK, the NIH data bank of DNA sequences and also to deal with sequences of any length. Progress has also been made in the automation of the DNA assembly programs.