Kaoru Kameda

Marked hyper-HDL2-cholesterolemia associated with premature corneal opacity: A case report

We report here a peculiar case with premature corneal opacity and extremely high levels of HDL cholesterol in serum. The patient is a 54-year-old man who was first noticed to have marked corneal opacities at age 19. His serum HDL cholesterol level was elevated to the level of 135-160 mg/dl, while total serum cholesterol and triglyceride concentrations were 254 mg/dl and 56 mg/dl, respectively. Serum apoprotein A-I and E levels analyzed by single radial immunodiffusion method were elevated in the case. Serum lipoprotein fractions isolated by preparative ultracentrifugation revealed that increased levels of HDL cholesterol were accounted for solely by the HDL2 fraction. HDL2 of the patient contained relatively higher amounts of apoprotein E than normal control HDL2. Elution profiles of lipoproteins in high performance liquid chromatography revealed that HDL2 particles from the patient were larger in size than those from normal controls. These characteristics of HDL are in part similar to those of HDLC which appears in experimental animals after cholesterol feeding. Such abnormalities in HDL2 fractions associated with premature corneal opacity have not been reported so far and appear to constitute a new disease entity.

Influence of endogenous hyperinsulinism on high density lipoprotein2 level in type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance.

We determined the insulin response to an oral glucose ingestion and levels of serum lipoproteins in 25 untreated patients with type 2 diabetes mellitus, in 26 subjects with impaired glucose tolerance (IGT), and in 35 non-diabetic control subjects. The three groups had similar compositions with respect to age and sex distribution. The levels of VLDL triglyceride in the subjects with type 2 diabetes or IGT were higher than those in controls. Serum HDL- and HDL2 cholesterol were significantly decreased in type 2 diabetics, and the subjects with IGT showed a similar tendency. Serum apolipoprotein A-II levels were lower in the male subjects with type 2 diabetes or IGT than in controls. Insulin response, i.e., sum of immunoreactive insulin (IRI) levels at basal, 30, 60, 90 and 120 min after a 75-g oral glucose load, negatively correlated to HDL- and HDL2 cholesterol levels (r = -0.396, P less than 0.05; r = -0.482, P less than 0.001, respectively), and positively correlated to VLDL triglyceride values (r = 0.485, P less than 0.001) in the male subjects with type 2 diabetes or IGT. In the female subjects, fasting plasma IRI values significantly correlated to HDL cholesterol (r = -0.496, P less than 0.05). There was a significant negative correlation between the concentrations of HDL2 cholesterol and VLDL triglyceride. These data show that lipoprotein metabolism, not only in type 2 diabetics, but also in IGT tends to show changes such as decreased HDL2 cholesterol and increased VLDL triglyceride levels, and which might be related to the hypersecretion of endogenous insulin.

Serum lipid levels in elementary and junior high school children and their relationship to relative weight

Serum lipid levels were measured in 2,626 schoolchildren ages 7 to 15 years in three elementary schools and one junior high school in a suburban area of Osaka during 1984-1985. The mean cholesterol levels increased with age in boys ages 7 to 10 years (from 156 to 177 mg/dl) and then decreased at age 13, after which the levels again increased slightly until age 15. Girls showed a similar tendency with a peak at age 10 and a minimum at age 12. Cholesterol levels were significantly lower in junior high school boys (a mean of 154-161 mg/dl for ages 13-15 years) than in girls of the same age or in boys and girls ages 10 to 12 years in the upper grades of elementary school. Cholesterol and triglyceride levels tended to be lower or the high-density lipoprotein cholesterol levels higher in elementary schools where boys and girls engaged in physical exercise than in schools where the children were not strongly encouraged to exercise. About 50% of the hypertriglyceridemic children were obese.

Triglyceride and Glucose Intolerance as a Risk Factor for Coronary Heart Disease

The electrophoresis of plasma lipoproteins frequently showed midbands between beta- and pre-beta-lipoproteins in survivors of myocardial infarction. There were increases in intermediate-density-lipoprotein (IDL) cholesterol and triglycerides with an increase in IDL cholesterol/triglycerides in the very-low-density-lipoprotein fraction, even if the increase in cholesterol was not so significant. Impaired glucose tolerance (IGT) was also frequently found in these patients. Among the patients with an apparently normal glucose tolerance, the coronary atherosclerosis scores judged by the American Heart Association reporting system on coronary angiography increased as the total insulin area by 75 g oral glucose tolerance test increased. The correlation between the atherosclerosis score and the insulin area was still significant even after adjustment for body mass index and plasma triglyceride level. Our data suggest that hypertriglyceridemia, IGT, and hyperinsulinemia may become independent risk factors for atherosclerosis in addition to cholesterol. Another study showed that the morbidity of coronary heart disease increased with an elevation of plasma triglyceride levels among patients with familial hypercholesterolemia.

A case of Behçet disease associated with bilateral pulmonary thromboarteritis

症例, 33才,男性. 29才よりBehcet病にて治療中.緩徐に進行する右心不全にて入院.精査にて左肺動脈基始部の完全閉塞,右肺動脈の高度の狭窄が判明,直ちに血栓除去術を施行.術後,右心不全症状は完全に消失した.手術時の肺動脈組織診により,肺動脈炎に伴う肺動脈血栓症の存在が確認された.本例は両側性肺動脈基始部にBehcet病に基づく閉塞病変を有するも,救命しえたまれな症例と考えられる.