H. M. Whyte

Distribution and turnover of cholesterol in humans

The relationships between some parameters of cholesterol metabolism and body weight were studied in 22 subjects. Cholesterol-4-(14)C, complexed with plasma lipoprotein, was injected intravenously and from the resultant specific activity-time curves a number of indexes of cholesterol turnover were calculated. These were based on the two-pool model previously described by Goodman and Noble and included estimates of the sizes of the two pools, the production rate of cholesterol in the system, the rate constants for cholesterol removal from the two pools and transfer between the pools, and the metabolic clearance of cholesterol. Single and multiple regression analysis was used to define the relationships between the turnover and distribution of cholesterol and the total weight and fat content of the body. The amount of cholesterol in the more rapidly turning over pool A, which probably includes cholesterol in liver, plasma, erythrocytes, and part of the viscera such as intestine, varied from 14.9 to 32.7 g. The mean value for the extraplasma part of pool A was 17.9 g. Making certain assumptions it was possible to derive estimates of the probable lower and upper values for size of pool B (exchangeable cholesterol in tissues other than in pool A), which were, on average, 35 and 60 g. The daily production rate of cholesterol (assumed to be equivalent to total turnover rate) varied between 0.73 and 1.68 g/day. The production rate of cholesterol and the size of pool B were significantly related to total body, and particularly to excess body, weight. When the plasma content was excluded, the amount of cholesterol in pool A was not related to weight. For a body of ideal weight the production rate was 1.10 g/day and the size of pool B between 32 and 53 g. For each kilogram of excess weight the expected increments were 0.0220 g/day and 0.90 g, respectively. The plasma cholesterol concentration was not related to the production rate or to the amount of cholesterol in the two pools. It was, however, inversely related to the fractional rate of removal from pool A and to the metabolic clearance rate of cholesterol which suggests that inadequate excretion could be of importance in the development of hypercholesterolemia.

Epidemiological studies in a total highland population, Tukisenta, New Guinea: Cardiovascular disease and relevant clinical, electrocardiographic, radiological and biochemical findings

Abstract A comprehensive survey of cardiovascular disease was carried out on 779 persons over 15 yr of age. Carbohydrate provided more than 90 per cent of caloric intake and the consumption of protein and salt were about 25 and 1 g daily, respectively. Drinking water was soft. The population was lean, physically fit and in good nutritional state. There was no increase with age in mean blood pressure, serum cholesterol (average 153 mg 100 ml ), fasting blood glucose or adiposity. Glucose tolerance was high. The average fasting serum triglyceride level was 142 mg 100 ml . Serum uric acid levels were not high. Pipe smoking was common. No diabetes or gout were found. There was a low prevalence of diagnosable cardiovascular diseases: hypertension, valvular disease, cardiac decompensation (mostly cor pulmonale) and cerebral and peripheral vascular disease. Ischemic heart diesase was rare if not absent as indicated by resting and post-exercise electrocardiograms. Rates for all codeable ECG items were low except low voltage and T wave changes (commonest in middle aged women). Age-related degenerative changes occurred, such as increasing diameter of the aorta and decreasing creatinine clearance, and the declining ECG voltage with age may be indicative of cardiac disease.

Plasma free fatty acid and triglyceride turnover in obesity

Abstract The turnover rate of plasma free fatty acids and of triglyceride in plasma very low density lipoprotein was studied in 15 obese subjects with a constant infusion of palmitic acid-1- 14 C. The plasma FFA turnover rate was significantly correlated with the plasma FFA concentration. The FFA turnover rate was also significantly related to fat mass, to fat mass as a percentage of total body weight and especially to per cent desirable weight. Since it was not related to body weight, it is evident that the plasma FFA turnover rate is related to the degree of adiposity as distinct from total body weight. The plasma triglyceride levels were on the average higher than normal in these obese subjects. The turnover rate of triglyceride in very low density lipoproteins was significantly correlated with the triglyceride concentration, and showed that increased formation was a major factor in the development of the hypertriglyceridemia.

Blood pressure and obesity.

Previous surveys have shown that height of observed blood pressure and degree of overweight are related. However, excess weight does not necessarily mean excess fat and the possibility of error in the measurement of blood pressure due to variations in the size of the arm has not been excluded. The present survey, taking these factors into account, shows that blood pressure is influenced by the total bulk of the body but not especially by fat except insofar as it contributes to total bulk. A possible explanation of the findings is offered.

A New Treatment of Barbiturate Intoxication

the frontal or temporal regions and the lapse of petit mal, and here the E.E.G. may be of critical importance in arriving at a correct diagnosis. You will have observed that I have attached a good deal of importance to the E.E.G. in distinguishing between central and partial seizures and in the localization of the site of discharge in the latter, but, as I have already indicated, the E.E.G. is by no means infallible. A positive E.E.G. depends first upon the chance of an epileptic discharge occurring while the record is being made. This chance may be a very small one, though various methods are now used to precipitate what are called subclinical seizures while the record is in progress. Nevertheless there are a great many cases in which we can be quite sure from the clinical evidence that the patient is suffering from epilepsy yet the E.E.G. is negative. This may be true for partial seizures even though the patient is having clinical attacks at the time the record is made. We recently had in the wards a man who was having partial seizures of precentral origin with tonic and clonic convulsive spasm involving the left side of the face and adversion of head and eyes to the left. These occurred frequently during the period of the E.E.G. record, which showed no abnormality. It is probable in this case that the discharge was arising deeply. One of the most interesting developments in recent years has been in our knowledge of the pathology of partial seizures, for which it seems possible that there is always an organic cause to be found-that is to say, a demonstrable histological lesion. The importance of scars, due to birth injury, neonatal anoxia, or encephalitis, has been increasingly revealed from the study of brain substance excised by neurosurgeons. Mr. Murray Falconers lecture has told of what is now being done in the surgical treatment of partial epilepsy.

Life events and myocardial infarction revisited: the role of measures of individual impact.

&NA; This study was conducted to test the hypothesis that patients with MI are distinguished from persons with a less serious illness, more by subjective interpretations of the emotional impact of life events than by exposure to a surfeit of life events that purportedly representative samples of the population have judged to be inherently stressful. Life events data consisting of frequency of events in the year prior to illness onset, cumulative weights of life change and distress derived from magnitude estimation scales, and visual analogue scales assessing the individually interpreted impact of events were collected for 120 patients with unequivocal MI, and contrasted with the same data collected for 40 patients admitted to coronary care but rapidly discharged without a diagnosis of MI or other serious illness. Differences between the two groups were not evident for life event frequency, magnitude estimation scales of life change and distress, or individual impact scales of life change. Individual impact scales of emotional distress did, however, distinguish between the two groups at a statistically significant level, suggesting that patients with MI have interpreted their life event exposure in the year prior to illness onset as being particularly emotionally distressing. While there may be methodological criticism of the research strategy used in the study, it is suggested that due regard for the experiential uniqueness of life event data has strengthened the relationship between life events and MI, which would not have become apparent with the application of a more conservative research strategy.

Pathology of Tangier disease

Two cases of Tangier disease are described in children from families unrelated to each other. Necropsy in one case, the first to be reported in this condition, showed large collections of cholesterol-laden macrophages in tonsils, thymus, lymph nodes, and colon, and moderate numbers in pyelonephritic scars and ureter. As the storage cells may be scanty in marrow, jejunum, and liver, the rectum is suggested as the site of choice for biopsy. The diagnosis was confirmed by demonstrating the absence of α-lipoproteins from the plasma of the living child, and by finding low plasma levels in both parents of both cases. The disease can be distinguished from other lipidoses by differences in the predominant sites of storage, staining reactions, and serum lipid studies.

Dimensions of illness behaviour in survivors of myocardial infarction

Abstract Psychological responses to illness of 120 survivors of myocardial infarction were examined using the Illness Behaviour Questionnaire (IBQ). All patients were seen in general hospital medical wards, 10–14 days after admission to hospital. Principal components analysis of the data with varimax rotation yielded 8 clinically meaningful factors accounting for 61.5% of the variance. These were interpreted as somatic concern, psychosocial precipitants, affective disruption, affective inhibition, illness recognition, subjective tension, sick role acceptance and trust in the doctor. These factors are consistent with common preconceptions of the experience of myocardial infarction and are similar, in part, to responses after myocardial infarction reported in a small number of previous studies. They are, however, only marginally similar to patterns of illness behaviour reported for other illnesses, which suggests that the nature of myocardial infarction imparts a unique quality to illness behaviour developed after it. The significance of these factors was discussed in terms of the contributions they might make to the more effective structuring of psychotherapeutic components of rehabilitation and secondary prevention following myocardial infarction.

Epidemiological Studies in a Highland Population of New Guinea: Environment, Culture, and Health Status

In assessing the impact of European influence on sociocultural characteristics of the Murapin tribal community of the Western Highlands of Australian New Guinea, the authors have gathered and, where possible, quantified information on family size, polygamy, marital status, religious beliefs, education, linguistic ability, economic development, occupation, housing, clothing, alcohol intake, and dietary patterns. Our findings suggest that the results of contact have not been uniform but that various social characteristics have been influenced at differing rates. European influence has been greatest in religion, less significant in matters of occupation, education, economic development, and housing, and negligible as regards diet. This differential effect of contact affords hope that it will prove possible to discriminate between various social and nutritional factors in their influence on the health status and biological characteristics of the population as the process of acculturation proceeds.

Guanethidine in treatment of hypertension.

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