Moriharu Misaki

Association of remnant-like particle cholesterol with coronary artery disease in patients with normal total cholesterol levels.

BACKGROUND Limited information is available as to whether there is a difference in the association of lipid and fibrinolytic variables with coronary artery disease according to the presence or absence of elevated serum total cholesterol. We examined the levels of various lipid and fibrinolytic variables including remnant-like particle cholesterol (RLP-C). RLP-C is a recently established simple assay method for the estimation of triglyceride-rich lipoprotein remnants. METHODS AND RESULTS Levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride, lipoprotein(a), RLP-C, uric acid, blood glucose, tissue plasminogen activator, tissue plasminogen activator inhibitor type 1, antithrombin III, and protein C were measured in 208 patients who underwent diagnostic coronary angiograms. Of these 208 patients, 57 were hypercholesterolemic (> or =220 mg/dL) and 151 were normocholesterolemic. HDL-C showed significant differences between patients with and those without angiographically determined coronary artery stenosis in both hypercholesterolemic and normocholesterolemic patients (P =.0025 and P =.0003, respectively). Both RLP-C and uric acid showed significant differences only in the normocholesterolemic subgroup (P =.0006 and P =.0060, respectively). This difference in uric acid was not significant by multivariable analysis. The ratio of RLP-C/HDL-C was demonstrated to be highly significantly (P <.0001) associated with coronary artery stenosis in patients with normal total cholesterol, whereas there was no statistically significant association in the hypercholesterolemic patient subgroup. CONCLUSIONS Our current study disclosed that RLP-C levels are strongly associated with coronary artery disease, especially in patients with normal total cholesterol levels. Moreover, RLP-C/HDL-C ratio may be even more significantly associated with the presence of coronary artery stenosis in normocholesterolemic patients.

Acromegaly and Hyperthyroidism Associated with McCune-Albright Syndrome

A 36-year-old man is described having McCune-Albright syndrome, acromegaly likely due to somatotroph hyperplasia and hyperthyroidism due to adenomatous goiter. Sexual precocity was not noted. The sella was narrow in size and no mass was seen. The decline of elevated GH by hyperglycemia and increase by GHRH-44(NH2) may support somatotroph hyperplasia, but plasma GHRH-44(NH2) levels were not elevated. A mass in the right lobe and enlargement of the left lobe of the thyroid were noted. Thyroid hormone levels in serum and thyroidal radioiodine uptake values were elevated, while TSH measurements in serum were low. The radioiodine scan showed a cold nodule in the right lobe and a hot area in the left of the thyroid. Thyroidal radioiodine was not suppressed following T3 given orally. These findings are compatible with functioning glands autonomously as the mechanism for the endocrinopathies associated with the McCune-Albright syndrome.

A Possible Relationship between Cord Blood Transferrin and Birth Length in Infants

Cord blood levels of transferrin (Tf) and insulin-like growth factor I (IGF-1) were measured in 33 normal and 12 preterm infants. Tf was measured by the single radial immunodiffusion technique, while IGF-1 was measured by specific RIA. Tf levels in normal term infants (195 +/- 27 mg/dl) were significantly below normal adult levels (261 +/- 12 mg/dl). Tf levels in preterm infants (159 +/- 30 mg/dl) were lower than those in normal term infants. Tf levels showed a positive correlation with birth length, weight, gestational age and albumin levels in all infants. There was no correlation between Tf and IGF-1 levels in term and preterm infants.

Paget's Disease of Bone Presenting with Peripheral Neuropathy

An 81-year-old hypertensive man presented with a high serum alkaline phosphatase (ALP) levels of 1,042 IU/L (normal 110-340) without subjective symptoms. His left knee and ankle jerks were abolished, without motor weakness. A decreased light touch and pinprick sensation in his left L4-S2 dermatome was noticed, and his vibration sense was impaired in the left leg. His index of bone turnover was markedly elevated with a urinary NTx of 255 nmolBCE/ mmolCr (13.0-66.2). Radiography showed an increased density, cortical sclerosis and tubercular coarsening in the ileum and sacrum (Picture 1). Bone scintigraphy showed a markedly increased uptake in the involved bones (Picture 2, arrow), indicated Paget’s disease of bone. Oral risedronate at 17.5 mg daily (1) was started. Forty days after starting treatment, his serum ALP and urinary NTx levels decreased to 478 IU/L and 20.2 nmolBCE/mmolCr, respectively. He showed improvement of the sensory disturbances and tendon jerks. Some non-compressive mechanism at the left sacral canal might have provoked peripheral neuropathy (2).

Studies on liver hexokinase

It has been actively studied in many laboratory to differentiate alkaline phosphatase isoenzymes in serum by using electrophoretic techniques, while it also became interesting problem to separate the several types of alkaline phosphatase by heating and chemical inhibitors. Eight cases (such as 3 ofhepatoma, 1 of gastric cancer, 1 &pancreatic cancer, 1 of uterus cancer, 1 of congestive heart failure and 1 of cholangiolitic hepatitis) with relatively heat-stable alkaline phosphatase which had more than 40~ of activity after heating at 56~ for 15min. are observed in 250 cases. Seven cases out of them were died within 2 months and it seems that presence of these relatively heat-stable alkaline phosphatase is a valuable fact for determining prognosis of the patients with severe disease. Serum from 22 cases who had malignancy and died showed remarkable changes of nature of alkaline phosphatase against several inhibition techniques, compared with normal serum. These serum alkaline phosphatase were quite sensitive against inhibition by EDTA, while were relatively stable against heating. Therefore, remarkable difference in ratio of EDTA stable activity/heatstable activity (56~ 15 rain.) was observed and it was 0.47 in these cases, compared with 1.10 in normal subjects and 1.57 in liver cirrhosis. In eight cases which were mentioned above, showed quite low value (0.19) in this ratio. It seems that this ratio is also useful tool for determining the prognosis of patients with malignancy. It is quite difficult question why these characteristic alkaline phosphatase appear in serum of the patients with malignancy or severe disease. More studies are required to dissolve this problem. It was quite interesting data which bile in gallbladder had heat-stable alkaline phosphatase, although liver enzyme was sensitive against heating.

Clinical studies on hexokinase and glucokinase in liver and blood serum

Since the level of activity of serum glucokinase is high in normal and low in liver diseases. Serum glucokinase may be considered liberated from the liver. The level of serum hexokinase is high in cancerous patient. In cancerous tissues, are increased generally not only the activity of the supernatant fraction but also that of the mitochondrial fraction in many cases. In the liver of cancerous patient the activity of hexokinase was found either extremely increased or not increased. In the cases of cancerous patients, there was observed the affinity for hexokinase to liver mitochondria.