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Elevated levels of serum lipids and lipoproteins are known to play a major role in the development of atherosclerosis and subsequent coronary heart disease (CHD). In controlled clinical studies, atorvastatin (Sortis), a new 3-hydroxy-3-methyl-glutaryl-coenzyme-A (HMG-CoA)-reductase inhibitor, proved to be a very effective and safe lipid-lowering agent. The aim of this open-label, multicentre study (without a control group) was to confirm the efficacy and safety of atorvastatin in a private practice group, including 181 Swiss cardiologists, internists, and general practitioners. A total of 877 hyperlipidaemic patients requiring treatment participated in this study. To evaluate the effectiveness of the treatment with atorvastatin over a period of 12 weeks, total plasma cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides (TG) were determined every 4 weeks. The initial atorvastatin dose was 10 mg in 78% of patients and 20 mg in 22%. The dose was doubled every 4 weeks until the target values of TC < or = 5.2 mmol/l and TC/HDL < or = 5 were reached. After 12 weeks of treatment with atorvastatin the mean reduction in TC, TC/HDL, LDL and TG compared to baseline levels was 33, 37, 42, and 25% respectively. At the same time the HDL concentration was increased by 9%. These results were evidenced in patients with existing coronary heart disease, in high risk patients without manifest coronary heart disease and in patients with significantly elevated lipid levels (TC > 7.8 mmol/l, TC/HDL > 6.5). After treatment with atorvastatin for 12 weeks, 59% of patients had reached the therapeutic target of TC < or = 5.2 mmol/l. The target of TC/HDL < or = 5 was reached by 79%. Atorvastatin was almost without exception well tolerated, the most frequently reported side effects being nausea, myalgia, and headache. In this open-label multicentre study atorvastatin was found to be effective and well tolerated. The observed reduction in the lipid and lipoprotein concentration is in accordance with the results of published controlled studies. The lipid and lipoprotein concentrations were decreased significantly in patients with slight to moderate elevation of lipid levels as well as in those with significantly raised values.

We attribute a case of acute irreversible renal failure associated with "blue toe syndrome" and eosinophilia to a cholesterol embolism after "successful" treatment of myocardial infarction with fibrinolysis. This case shows that CE can be caused not only by invasive arterial procedures but also by thrombolytic as well as by anticoagulant treatment. In modern medicine, the importance of this often fatal but usually undetected systemic affection is increasing. For patients with serious atherosclerosis it is essential to analyze the risks and benefits before undertaking arterial invasive procedures or fibrinolysis.

Conventional lipid-lowering agents displayed only limited efficacy in lowering total and LDL cholesterol and a high incidence of side effects. Pravastatin is a new potent cholesterol-lowering agent, which selectively inhibits hepatic HMG-CoA-reductase. In a double-blind, placebo-controlled Swiss multicenter study with determination of lipids and lipoprotein in a central laboratory, the efficacy and safety of 6 months' therapy with pravastatin was evaluated in 50 patients with mild hypercholesterolemia and additional coronary risk factors. Compared to baseline and after 26 weeks' therapy, pravastatin significantly reduced total cholesterol (pravastatin vs placebo, -17% vs +7%, p < 0.0001) and LDL cholesterol (-26 vs +2%, p < 0.0001). The total/HDL cholesterol ratio ( = "atherogenic index") was comparable in the two groups at baseline (5.9 +/- 1.1 vs 6.3 +/- 0.9), and was distinctly lowered by pravastatin but not placebo (-20 vs 0%, p < 0.0001). In 11 patients in whom the reduction of serum total cholesterol after 13 weeks' treatment with 20 mg pravastatin was still below target (on average -9.1%), doubling of the dose produced a further decrease of 4.3%. Serum HDL cholesterol and serum triglyceride levels did not change significantly during pravastatin treatment as compared to baseline and placebo. Pravastatin was well tolerated during the 26 weeks without relevant subjective side-effects. There were 5 dropouts during the study, 2 patients in the pravastatin group and 3 in the placebo group. These findings document that pravastatin, administered in a single daily dose of 20 to 40 mg, effectively lowers serum cholesterol and total-/HDL-cholesterol improving action and is well tolerated.

The Swiss Cancer League ist the head organization of 19 cantonal and regional cancer leagues with a total of over 60,000 members. Its goal is cancer control on a medical-scientific basis. The League is working toward this goal by funding of research, information and social service. The funding of research is done through grant applications similar to the rules of the Swiss National Fund. Basic and applied research are equally supported. Information is increasingly transmitted through national campaigns (melanoma prevention, cancer and nutrition, European Code). Social services are decentralized and taken care of by the cantonal and regional leagues. The principal revenues derive from private donations (bequests, card sales etc.).

A kindred is described in which several members have evidence of sick sinus syndrome and of conduction disturbance. The data suggest that in this family the rhythm disturbances were transmitted as an autosomal dominant trait whose penetrance increase with age. The occurrence of Adams-Stokes episodes required pacemaker implantation in 6 patients. In one case the arrhythmia is associated with a cardiomyopathy of unknown origin. No pathological studies were conducted. In one case the His bundle electrogram was recorded.

In a double blind study 27 patients with type II hyperlipidemia (8 IIa and 19 IIb) were treated as follows: 13 received placebo and 14 sn-polyenylphosphatidylcholin (PPC) (P 0206/1/01, Nattermann GmbH, Cologne) in a dose of three times 450 mg b.i.d. In all patients, and also in the two subclasses of patients with type IIa and type IIb hyperlipidemia, total cholesterol and LDL cholesterol were lowered significantly by PPC. The other parameters showed only minor variation. There was a downward trend in apoprotein B, triglycerides and VLDL cholesterol, and an upward trend in apoprotein AI, with virtually unchanged HDL cholesterol. None of these variations was significant compared with placebo. The fall in LDL cholesterol with unchanged HDL cholesterol caused a statistically significant decrease in the LDL cholesterol/HDL cholesterol ratio, thus supporting the hypothesis of an antiatherogenic property of PPC, as demonstrated experimentally in various animals.

The hypolipidemic effect of acipimox, a new inhibitor of lipolysis, was investigated in a double blind crossover trial versus placebo. The trial showed an appreciable and significant reduction in total cholesterol (-14%) and of LDL cholesterol (-20%), a slight but significant increase in HDL cholesterol (+6%), and only a slight diminution of triglycerides and VLDL cholesterol.

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.

Bezafibrate, a new hypolipidemic agent, was evaluated in a single blind, placebo-controlled study lasting 14 months to 3 years in 40 patients with primary hyperlipoproteinemia of various types (23 patients with type II, 15 with type IV and 2 with type V). Bezafibrate in a dose of 200 mg 3 times daily reduced total serum cholesterol by an average of 17% (p less than 0.001) in hyperlipoproteinemia type II and by 24% (p less than 0.001) in type IV or V, lowered serum triglycerides by 31% (p less than 0.001) in hyperlipoproteinemia type II and by 58% (p less than 0.001) in type IV or V, while high-density-lipoprotein-cholesterol was increased by 17% (p less than 0.001) in type II and by 36% (p less than 0.001) in type IV or V. The few side effects encountered were only mild and transient. These findings show that bezafibrate affords safe and effective long-term treatment of patients with hyperlipoproteinemia.

Hypolipidemias can be divided in primary, familial and hereditary forms and symptomatic forms which may accompany other diseases. The primary hypolipidemias (abetalipoproteinemia, hypobetalipoproteinemia and analphalipoproteinemia) are very rare. Severe hypolipidemia can be found in some peoples (e.g. the Masai). This article is chiefly devoted to secondary hypolipidemias such as those associated with malabsorption, malnutrition and maldigestion including protein-losing gastroenteropathy, with liver diseases, endocrine diseases (hyperthyroidism, hirsutism) and anemia. Finally, the hypolipidemias secondary to the formation of autoantibodies against HDL and LDL in M-gradient, carcinoma and rheumatoid arthritis are briefly reviewed.

Possible cardiac involvement has been investigated in 103 cases of salmonellosis. 12 patients showed pathological clinical, laboratory and ECG findings suggesting heart damage during the course of the infectious disease. In 2 cases acute fibrinous pericarditis was diagnosed, in 1 case acute effusive pericarditis and in 1 patient acute peri-myocarditis. In the remaining 8 patients the pathological findings suggested the presence of myocarditis. The heart involvement may be the predominating clinical sign, as shown in 3 out of our cases, but in the majority the cardiac symptoms are only very slight. These data indicate that heart involvement is less rare in salmonellosis than is generally thought. On the other hand, salmonellosis should be considered in cases of peri- or myocarditis of unknown origin.

In an unselected series of 12 patients with Sjögren's syndrome the following autoimmune diseases were observed: severe myxedema due to Hashimotos thyroiditis in four, subclinical thyroid hypofunction in one, diffuse hyperthyroidism in one, glomerulonephritis in two, chronic active hepatitis in one, lupus erythematodes disseminatus in three (one with idiopathic thrombocytopenic purpura), classical rheumatoid arthritis in two. A rare familial occurrence was seen in two sisters. The only male in this group exhibited coexistence of a benign adenolymphoma of the parotid gland (Warthin's tumor) with a malignant non-Hodgkin lymphoma.

Report on an 18-year-old patient who developed a respiratory distress syndrome after trauma without bone fractures and with only minimal soft tissue contusion. Twelve hours after the accident fever and dyspnea appeared, accompanied later by hemoptysis, microhematuria, a fall in hemoglobin and in platelet count, petechiae on the skin and in the conjunctiva, cotton-wool lesions in the retina and micronodular shadows in the lungs. Various pathogenetic mechanisms other than bone marrow fat embolism are discussed in the light of this case.

A woman with morphologically and cytochemically confirmed hairy cell leukemia also showed the typical signs of myeloma (paraproteinemia IgG/k, Bence-Jones-k-paraproteinuria, numerous partly atypical plasma cells in the bone marrow, diffuse osteoporosis of the spine and osteolytic lesions in the skull). This observation strongly supports the hypothesis of a direct relationship between hairy cells and plasma cells.

17 patients with hyperlipoproteinemia of type 11 (9 type IIa and 8 type IIb), 4 with hyperlipoproteinemia of type IV and 1 with hyperlipoproteinemia of type V were treated for 4.6 +/- 0.7 months with the new lipid lowering agent bezafibrate in a dose of 200 mg three times daily. Bezafibrate markedly lowered total serum cholesterol and triglycerides and increased HDL-cholesterol in each of these types of hyperlipoproteinemia. These data suggest that bezafibrate may be effective in reducing the possibly atherogenic LDL- and VLDL-fractions while increasing the antiatherogenic HDL-fraction.

Despite the large number of available chemotherapeutic agents and antibiotics, monotherapy is not always possible. The practical indications for antibiotic combinations are discussed and the controversial topic of chemotherapeutic prophylaxis in different clinical situations is raised.

Investigations of HDL with zonal ultracentrifugation were carried out in three patients with apolipoprotein AIMilano. HDL in patients with AIMilano apolipoprotein are characterized by the practically total absence of HDL2. The HDL3 peak is broader than normal. In spite of the marked reduction or practically total absence of HDL2, which is believed to be a protective factor against atherosclerosis, our patients show no signs of clinical atherosclerosis.

Presence of anti-lipoprotein activity, a new serological finding in inflammatory rheumatoid disease, has been established in sera and synovial fluids of 20 patients, among which were 6 cases of ankylosing spondylitis. In 18 of the patients, sera were negative for rheumatoid factor. Anti-lipoprotein activity can best be demonstrated by the hemagglutination technique. The binding activity is directed against autologous as well as homologous, however not against heterologous HDL and LDL. It has no specificity for Ag factors. Anti-LDL activity can also be demonstrated by means of double-diffusion tests, whereas no agar-precipitation has been noticeable using HDL as the antigen. Lipoprotein binding-activities were shown to be localized in the Fab fragments of IgG and, in 2 of the cases, also in IgA. We therefore assume that the underlying mechanism of the antilipoprotein activity is auto-immunization, despite of the fact that neither activation of complement nor a stoichiometric character of the binding reaction could be ascertained. Because hemagglutination and immunoprecipitation tests, respectively, were postive with apo-HDL und apo-LDL too, we consider the apo-protein to carry the antigenic site of the reaction. Sera with anti-lipoprotein autoantibodies from patients with chronic rheumatoid disease also presented another pecularity, i.e., a significant decrease of total lipids, cholesterol, and other components of the lipid spectrum. In patients with paraproteinemia, a similar combination of lipoprotein-binding activity and hypolipidemia or hypocholesterolemia was discussed in a previous paper. Regarding the pathogenesis of hypolipidemia or hypocholesterolemia in our patients with rheumatoid disorders, results of LDL turnover studies were indicative for an increase of the lipoprotein catabolism in the presence of anti-lipoprotein autoantibodies, together with a shift of the intra-extravascular distribution toward the intravascular pool. We assume the increased lipoprotein catabolism in these cases to be due to a trapping of lipoproteins by autoantibodies, and to accelerated degradation of these immune complexes. From a practical point of view, it may be of clinical importance that this new serological finding has been observed mainly in patients with chronic rheumatoid disease lacking a rheumatoid serum factor, and was frequently found in patients with ankylosing spondylitis (6 out of the 20 cases). As a screening method, we recommend systematic determinations of the total lipids and of serum cholesterol in all patients with inflammatory rheumatoid disease. In cases with low levels of total lipids and cholesterol, respectively, it may be useful to search for anti-lipoprotein autoantibodies using the hemagglutination method. Results are reported from some preliminary experiments on animals elicitation of an arthritis by means of intra-articular injections of autologous apo-HDL and apo-LDL, and demonstration of autoantibodies against HDL and LDL).

15 outpatients with type II hyperlipoproteinemia (7 with type IIa and 8 with type IIb) were treated with soybean. This diet induced a significant decrease of plasma cholesterol levels from 314 +/- 24 to 267 +/- 30 mg/100 ml. Triglycerides levels remained unchanged. LDL-cholesterol decreased significantly from 241 +/- 26 to 194 +/- 32 mg/100 ml, whereas HDL-cholesterol increased only slightly and not significantly from 38 +/- 7 to 40 +/- 8 mg/100 ml. In our efforts to reduce hyperlipidemia the very low cost of these vegetable proteins is a further advantage. The hypocholesterolemic mechanism of soybean diet is unknown.