[Behavior of high-density lipoproteins in drug lipid-lowering treatment]

Changes in serum lipids, the individual lipoprotein fractions after ultracentrifugation and the apoproteins B, A1 and A2 were studied in 66 patients with primary hypercholesterolemia under treatment with different lipid-lowering agents. After 3 months with dietary treatment alone and a 4-week placebo period the patients were given bezafibrate (3 X 200 mg daily), colestipol (2 X 10 g per day) or probucol (2 X 500 mg daily) for 12 months, followed by another 4-week placebo period at the end of the study. Colestipol showed the best lipid-lowering effect (total and LDL cholesterol were decreased by 20% and 23% respectively) but satisfactory total and LDL cholesterol lowering results were also obtained with the other substances. However, the changes in HDL differed widely among the three substances: bezafibrate increased HDL cholesterol and the HDL apoproteins A1 and A2 significantly, colestipol did not alter these parameters, while probucol treatment was followed by a significant decrease in both HDL-cholesterol and the apoproteins A1 and A2.

[Clinical data on Legionnaires' disease. Report on 8 sporadic cases of Legionella pneumonia]

In 1978 and 1979, eight sporadic cases of Legionella pneumonia were observed in the Berne and Ticino areas of Switzerland. In all cases the diagnosis was established serologically using indirect immunofluorescence. Seroconversion was observed in five patients. In three cases initially high antibody titers decreased progressively. The clinical picture was characterized by acute onset with high fever, frequent chills, and dry cough. Occasional concomitant symptoms included muscular pains, headache, thoracic pain, dyspnea, hemoptysis, and gastrointestinal and central nervous symptoms. Laboratory findings showed markedly increased BSR as well as slightly increased WBC with a pronounced shift to the left. In all cases, X-ray examinations demonstrated extended, mainly unilateral and often remarkedly peripheral infiltrations of the lung. On the basis of the clinical course, two groups could be distinguished: (a) non-complicated cases of pneumonia with rapid improvement within 2-3 weeks; and (b) cases with a protracted sometimes severe course with persistence of the infiltrations up to 4 months and more. All patients with a protracted course suffered from concomitant symptoms. Whereas none of the patients died of legionellosis, two patients died six months later from their underlying disease. Most patients were treated with several antibiotics. In three patients definite improvement occurred only after therapy had been changed to doxycycline. Erythromycin, currently recommended as the drug of choice, was used in none of these cases.

[Discovery of Legionella pneumophila: achievement in modern bacteriology]

The discovery of Legionella pneumophila is described and the clinical and epidemiological aspects of legionellosis (Legionnaire's disease) are presented. "New" pneumonia agents discovered after isolation and description of Legionella pneumophila, and which as yet lack definite designations, are mentioned. Up to June 1980, two additional bacilli not identical with Legionella pneumophila have been described and variously named, i.e. 1. WIGA (probably identical with ALLO), 2. TATLOCK (probably identical with HEBA and PPA). A third potential "new" pneumonia agent, named TEX-LK, must be added although it has been isolated in only one case of pneumonia.

[Alveolar carcinoma of the lung. Anatomo-clinical considerations and presentation of 4 cases]

Alveolar carcinoma of the lung is a rare form that is often discovered casually, and may well be asymptomatic. Four personal cases are presented. The view is advanced that this is a distinct form that is clearly distinguishable from bronchogenic adenocarcinoma. It has a single site and is derived from the type II pneumocyte. Particular attention is given to the clinical and diagnostic features of alveolar carcinoma. It is felt that early diagnosis followed by radical surgery leads to a marked improvement in prognosis.

[Procetophen--an alternative in the treatment of hypercholsterinemia?]

18 patients with primary hyperlipoproteinemia of type IIa and type IIb, on regularly controlled dietary treatment for 6 months and a 4 weeks placebo period, were given 300 mg procetofene per day for 12 weeks. The subjective tolerance of the drug was good. The serum triglyceride levels were lowered by about 35%, total cholesterol by 15%, LDL-cholesterol by 12% and Apo B by 20%. The HDL-cholesterol values remained unchanged. A slight increase in SGPT values indicates that liver function should be regularly checked in patients undergoing procetofene therapy.

[Fever of long standing in atrial myxoma]

A 39-year-old man is described who presented with the unspecific signs of systemic disease (elevated erythrocyte sedimentation rate, increased gamma-globulins, positive rheumatoid factor; clubbing, splenomegaly) and with fever whose origin remained undiagnosed for 8 years despite numerous investigations. Later in the course of the disease, the signs of mitral stenosis appeared, suggesting left atrial myxoma even in the absence of arterial embolization. This diagnosis was established by echocardiography and confirmed by angiocardiography as well as at operation, after which all the systemic signs and symptoms disappeared.

[Treatment with high-dose beta-pyridylcarbinol: results in patients with hypercholesterinemia]

The effect of lipid-lowering therapy with high-dose beta-pyridylcarbinol was studied in 16 patients with primary hyperlipoproteinemia of type IIa and type IIb. After a controlled dietary pretreatment period of at least 3 months, the patients received 900 mg beta-pyridylcarbinol (Ronicol 300) per day for 12 weeks. The patients were then given only dietary treatment for a further 6 weeks. Clinical and laboratory controls were carried out every month and included measurement of cholesterol and triglycerides in whole serum and in the isolated lipoprotein fractions after ultracentrifugation. In 2 patients the treatment had to be discontinued due to side effects (flush). The numerous "safety parameters" were not affected by the treatment. Total and LDL cholesterol were lowered by about 15% and total triglycerides by about 25%. The HDL cholesterol levels remained unchanged.

[Familial hypobetalipoproteinaemia and diabetes mellitus (author's transl)]

In a 60-year-old patient with manifest diabetes mellitus and in his 63-year-old brother with latent diabetes mellitus hypobeta-lipoproteinaemia was diagnosed. Cholesterol values were around 1,8 mmol/1 in whole serum samples. The LDL-cholesterol fraction was 1,04 mmol/1. The beta-lipoprotein band in the lipoprotein electrophoresis was markedly reduced. Apolipoprotein B measured by radial immuno-diffusion was about 30% of the normal for age. The components of LDL were normal. Values of hepatic triglyceride lipase and lipoprotein lipase in heparinised plasma were within the normal range. The simultaneous occurrence of hypobetalipoproteinaemia and diabetes mellitus is described here for the first time.

[Serum lipids in diminished kidney function, during hemodialysis and after kidney transplantation]

Lipids have been investigated in three groups of patients with chronic renal insufficiency. 19 patients were on conservative treatment (no dialysis), 52 patients were on regular hemodialysis, and 27 patients had been transplanted. The results were compared with those obtained from control subjects of the same age and sex. Hyperlipoproteinemia was found in 25% of the uremic patients, 55% of hemodialysis patients, and 85% of transplant recipients. The predominant lipid abnormalities were hyperlipoproteinemia of Type IV in both uremic (5 out of 19) and hemodialysis patients (17 ou of 52). Hyperlipoproteinemia of Type II was mainly observed after transplantation (IIb: 13, IIa: 5 out of 27).

[Changes in serum lipids and lipoproteins in acute hepatitis]

In 50 patients with acute hepatitis serum lipide and lipoproteins were determined at regular intervals and the results were compared with the usual liver function tests. Australia-antigen was established in 26 patients. During the first three weeks of the disease the most striking finding was a significant increase in the triglycerides, which was most pronounced at the end of the second week. Triglyceride levels usually returned to normal during the fourth week. In the course of the disease, lipoprotein electrophoresis showed marked decrease or absence of alpha- and pre-beta-lipoproteins during the first two weeks. During the third week faint alpha and pre-beta bands recurred in most patients. By the end of the fourth week lipoprotein electrophoretic findings were back to normal. There was general correlation between routine tests of liver function and results of lipid analyses throughout the course of the disease. This typical pattern of serum lipid and lipoprotein changes was found with near-consistency in patients with HAA-positive hepatitis. It was also present in the majority of HAA-negative patients, though in these the characteristic discrepancy between hypertriglyceridemia and simultaneous decrease of the pre-beta-lipoprotein band in eletrophoresis was, on the average, absent.

[Lymphoproliferative diseases and paraproteinemias in Sjogren's syndrome]

Out of 8 cases of Sjörgren's syndrome observed by the authors between 1964 and 1974, 5 presented wit clinically as well as theoretically remarkable combinations of Sjögren's syndrome with lymphoproliferative disorders i.e. non-classifiable lymphoproliferative disease (case 1), Hodgkin's disease (case 2), reticulum cell sarcoma (case 3), and asymptomatic paraproteinemia of type IgM/K (cases 4 and 5). In case 1, manifestation of a lymphoproliferative disorder was preceded by autoimmune hemolytic anemia. In agreement with communications from several other authors, our observations confirmed the frequent occurrence of autoantibodies in patients with Sjörgren's syndrome. Forty-two more cases of lymphoproliferative disease in Sjögren's syndrome were found in the literature (Table 4). Pathologenetic problems arising from these nosological combinations are discussed.

[Synthesis and antibacterial activity in vitro of some penicillins containing the phenylcyclohexanie residue]

Some penicillins with structures similar to that of ampicillin and cyclacillin bearing the phenylcyclohexane grouping were prepared. In vitro tests of antibacterial activity showed that the introduction of this residue led to reduced activity in comparison with that of the parent compound.