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Excerpt The results of the National Cooperative Gallstone Study reported in 1981 (1) were disappointing. After patients received chenodiol, 750 or 375 mg/d, or placebo for 2 years, complete dissolu...

Hyperlipidemia has been reported in patients with symmetric peripheral neuropathy or mononeuropathy multiplex 1-8 ; however, to our knowledge, it has not been previously reported with tarsal tunnel syndrome or other entrapment syndromes. We studied a man with type V hyperlipidemia and posterior tibial nerve entrapment at the ankle. REPORT OF A CASE In a routine examination of an asymptomatic 36-year-old man, the following values were found: blood cholesterol, 365 mg/ dL; triglycerides, 1,475 mg/dL; and fasting glucose, 107 mg/dL. After several months on a low fat diet, cholesterol content was 252 mg/dL, and triglycerides content was 574 mg/dL. In September 1980, at the age of 42 years, he began taking cholestyramine resin for treatment of hyperlipidemia and noted numbness of the right great toe, followed by numbness and painful burning of the left medial three toes. The pain made walking difficult, and he stopped working four weeks after onset.

In Reply.— Dr Cenedella is correct in pointing out the potential for inhibitors of cholesterol synthesis to induce cataracts, particularly in young individuals. Pediatric use of lovastatin has been limited to patients with serious genetic disorders, mainly children with homozygous familial hypercholesterolemia. One of us (J. A.T.) has analyzed results of all the ophthalmologic examinations in patients taking lovastatin. Slit-lamp examination of the lens was performed at the baseline examination and during treatment in over 500 patients. The mean age of the patients studied was 50 years; 60% of them had heterozygous familial hypercholesterolemia and 50% had ischemic heart disease. The prevalence of lens opacities in these patients was 27% at the baseline examination and 31% at the last available examination during treatment with lovastatin. Interpretation of these data is complicated by the subjective nature of slit-lamp examination, uncertainty regarding the natural incidence of lens opacities in patients with severe

The 15th Ciba Foundation Colloquium on Endocrinology, held in England in October 1963, was organized to review information pertaining to the pathogenesis of diabetes mellitus and its complications, particularly with respect to human rather than experimental disease. The small but distinguished list of guests, naturally somewhat weighted with representatives from Great Britain, includes many of the best-known names in the field. The volume opens with chapters on the epidemiology of diabetes by Walker and the genetic aspects of diabetes in the Chinese hamster by Yerganian. Ogilvie and Lacy contribute descriptions of the morphology of the diabetic pancreas and its beta cells. A section on the biosynthesis and secretion of insulin includes chapters by Taylor, Renold, Fajans, and Randle. Renold and Hales write on plasma insulin, and various types of insulin antagonism are discussed by Kipnis, Randle, Vallance-Owen, Bornstein, and Butterfield. Chapters on the biochemistry of blood vessels by Muir and

Bile salts have deleterious effects on a variety of organs, cells, and subcellular organelles. Several bile salts, predominantly monohydroxy bile salts, have the capacity to produce cholestasis and changes in gross liver structure and hepatocytic ultrastructure in experimental animals and in vitro preparations. It is also apparent that liver disease results in profound changes in the pattern of bile acid metabolism, some of which theoretically could be harmful and some protective. It is not possible at present to give a clear answer to the question of whether bile salts participate in the initiation or perpetuation of human liver disease, although the evidence reviewed here suggests that in certain circumstances they may.

This book contains the proceedings of the conference on Gout and Purine Metabolism held in October 1964. Originally published as a supplement to Arthritis and Rheumatism , it is now being offered in hardback form. All of the recognized authorities have contributed, and a great deal of data has been collected in one place. It must be recognized, however, that the data is at least three to four years old now, a serious consideration in evaluating a book dealing with a field that is practically exploding with new knowledge. For those expressly interested in period photographs for historical purposes, the book may serve as a sight-seeing postcard packet from 1964—and will be opened just about as often.

Professor Muntwyler, in his preface, indicates that his intention in writing this monograph is to provide "a detailed and simplified treatment of various fundamental principles and... examples of practical application." The material forms the basis for an elective course in applied biochemistry, and the book gives the impression of being best suited for that particular audience. The simplified principles are presented in great detail with formulae, equations, and many numerical examples and diagrams. However, this tends to make a textbook that, while valuable for the student, would not be easily read by a practicing physician who might wish to review principles. On the other hand, it cannot; its simplified treatment does not lend itself as a reference book for those with any knowledge of the field. The volume devotes 58 pages to water and electrolyte metabolism, 66 pages to acid-base balance, and 20 pages to correction of fluid, electrolyte, and

In this fourth edition, Black has adhered to his original tenet of brevity and generality with commendable tenacity. Furthermore, the clarity and conciseness with which he discusses fluid balance leaves one with the feeling that the 150 pages he used were precisely sufficient to cover the waterfront. The book is packed with protein and sprinkled with wit, but it is easily digestible. The chapter on "hydrion," or hydrogen ion, is, I judge, new to this edition. The Bronsted-Lowry nomenclature is used throughout, but the chapter is more than just a rewording of an old concept. The emphasis has been changed in keeping with the title. The result is a succinct, understandable, and up-to-date treatment of a subject that has been improperly presented for too long a time. The book should be of great value to the student interested in a comprehensive introduction to problems of fluid and electrolytes; to the

A number of 5β-H steroids derived from the endogenous metabolic transformations of cholesterol and gonadal and adrenocortical hormones have been shown to evoke intense pyrogenic reactions when injected into humans. The structural basis and species specificity of this form of biological activity have been described in previous communications from this laboratory.1-7 The present report examines in detail certain other aspects of steroid pyrogen action, utilizing 11-ketopregnanolone as a chemical prototype of this class of fever-producing agents. This C21 5β-H steroid was selected for use in this study because of its potency, its physiologic origin, and its ready availability in large amounts and in pure form through chemical synthesis. The characteristics of the thermogenic and inflammatory responses induced by this compound may, on the basis of extensive comparisons made with structurally related steroids, be considered to typify those induced generally by appropriate administration of neutral steroid pyrogens to man. Methods

A textbook which reaches its tenth edition, spanning 27 years, obviously serves a purpose for a large number of medical personnel. Written for students and practitioners, The Textbook of Medical Treatment was designed to fill the gap between textbooks in medicine and pharmacology; it is more detailed than the former and more generalized and covering more nonpharmacological aspects of therapy than the latter. It was written, edited, and published in Great Britain, and its role is so similar to that of Current Therapy (H. F. Conn [ed.], Philadelphia: W. B. Saunders Co.) in American medicine that comparison is inevitable. The organization of both books is similar, dealing with the management of diseases of sundry etiologies in various organ systems, but in many ways the two books reflect some of the traditional differences (real or imagined) between Great Britain and America. The American book, printed in large, black, "easy-to-read" type

The fifth edition of Diseases of Metabolism is, like its predecessors, a well-written, easily readable book that will be cordially welcomed and extensively used by students, house staff, and other physicians interested in metabolism and endocrinology. It continues the fine tradition of previous editions and will no doubt enjoy a healthy demand due to its unique treatment of the biochemical aspects of clinical disease. A few chapters have been rewritten by new authors, but the major changes in the present edition (1,513 pages vs 1,073 pages for the