Rachel K. Younger

Alterations in plasma lipid concentrations in normal and hyperlipidemic patients with morbid obesity before and after jejunoileal bypass

In a study of 193 massively obese patients plasma lipoprotein concentrations were elevated in 94 patients and were within normal limits in 99 patients. Jejunoileal bypass, in addition to causing weight loss, lowered plasma lipids in both groups to normal or below normal levels.

Effects of distal intestinal bypass and other gastrointestinal operations on experimental hypercholesterolemia and atherosclerosis

Abstract Further appraisal has been made of the effects of distal intestinal bypass in experimental hypercholesterolemia and atherosclerosis in dogs. In this study, bypass of 30 to 40 per cent of distal small intestine successfully prevented the development of hypercholesterolemia and atherosclerosis in animals on a vigorous atherogenic regimen; the test regimen included an experimental model which had been previously shown to enhance segmental deposition of atheroma. Bypass of 15 per cent of small intestine was not satisfactory in this regard, although both 15 per cent bypass and 15 per cent resection afforded a limited degree of protection against induced hypercholesterolemia and atherosclerosis. Very little difference was observed between the excellent protective effects of 30 per cent intestinal resection and 30 per cent intestinal bypass in these preliminary experiments. Comparison of the effects of truncal vagotomy and selective gastric vagotomy in animals on atherogenic regimen suggests that truncal vagotomy offers a modest protective effect against hypercholesterolemia and experimental atherosclerosis whereas selective gastric vagotomy offers no protection whatsoever. Further evaluation of the preventive effects of 30 to 40 per cent intestinal bypass and the other gastrointestinal operations in experimental atherosclerosis is clearly indicated and an assessment of their therapeutic value in established experimental atherosclerosis must be made.

Cholesterol reduction by a high-glucose diet in a patient with homozygous familial hypercholesterolemia: A preliminary report

Homozygous familial hypercholesterolemia is refractory to standard dietary or drug therapy. Recent studies, however, suggest that a high-carbohydrate/low-fat diet may reduce circulation cholesterol levels in normal or hyperlipidemic subjects. In this regard, we treated a nine year old boy with homozygous familial hypercholesterolemia with a liquid formula diet containing 82 to 90 percent of total calories as glucose. The diet was given as a constant nasogastric infusion or as intermittent daytime drinks followed by a nighttime infusion. Plasma total and low-density lipoprotein cholesterol fell from basal levels of 719 mg/dl and 676 mg/dl to 456 mg/dl and 434 mg/dl, respectively, after one week of therapy. After approximately 14 weeks of treatment, plasma total and low-density lipoprotein cholesterol levels were 311 mg/dl and 277 mg/dl, each representing approximately a 58 percent decrease from basal levels. The fall in circulating cholesterol levels was accompanied by a regression of xanthomatous skin lesions, a rise in plasma insulin levels and no change in plasma glucose or glucagon concentrations. No adverse effects of therapy occurred. We conclude that high-carbohydrate diets may be a safe and effective adjunct in the treatment of homozygous familial hypercholesterolemia.

The effect of abdominal aortography on proximal renal tubule function

Summary The influence of the contrast media used in abdominal aortography on renal para-aminohippuric acid extraction, a measure of proximal tubular function, has been assessed. In dosages of 0.5 and 1.0 ml. per kilogram of body weight Angio-CONRAY 80%, Hypaque M-90%, Renovist 69%, and Renografin 76% caused no significant change in PAH extraction. In contrast, Urokon 70% in 0.5 ml. per kilogram dosage caused immediate, severe, but transitory impairment of PAH extraction. Urokon 70% in 1.0 ml. per kilogram dosage caused immediate, severe, and lasting impairment of PAH extraction.