Combination treatment with cholestyramine and bezafibrate for heterozygous familial hypercholesterolaemia.

Cholestyramine and bezafibrate were compared individually and in combination in the treatment of 18 patients with heterozygous familial hypercholesterolaemia. The study used a double blind, placebo controlled block design with a placebo run in period of two months followed by three phases of active treatment, each of two months'' duration. Patients were randomly allocated to one of the six possible sequences of medication so that three patients would be treated with each sequence. Two patients withdrew from the study before completion. The median concentration of total cholesterol decreased from 9.65 mmol/l (interquartile range 8.62 to 8.72) to 7.24 mmol/l (6.70 to 7.52) with cholestyramine, to 8.09 mmol/l (7.18 to 8.68) with bezafibrate, and to 6.31 mmol/l (5.84 to 7.27) with the combination. This fall was due almost entirely to a decrease in the low density lipoprotein cholesterol concentration, and the combination was significantly more effective than either drug alone. The 98% confidence intervals for the median differences between the combination and cholestyramine and the combination and bezafibrate were 0.04 to 1.49 mmol/l and 0.51 to 2.18 mmol/l respectively. These results suggest that this combination is an effective and useful treatment in heterozygous familial hypercholesterolaemia.     

ST-segment elevation associated with allergic reaction to echocardiographic contrast agent administration

We report a case of an allergic reaction after the administration of an echocardiographic contrast agent which resulted in ST-segment elevation. Hypersensitivity and allergic reactions are known causes of acute cardiovascular events. However, only limited reports are available which suggest the exact mechanism of the occurrence of angina or myocardial infarction during severe allergic reactions. In our case, through invasive imaging (coronary angiography and IVUS) we have shown for the first time a transient coronary spasm in the absence of intra-coronary thrombus and only minimal neointimal hyperplasia.     

Trichinella spiralis: Proteins and antigens isolated from a large-particle fraction derived from the muscle larva

Proteins and antigens derived from a large-particle fraction of muscle larvae of Trichinella spiralis (i.e., the S₃ fraction) were characterized in terms of their molecular weights, isoelectric points, carbohydrate contents, electrophoretic mobilities, antigenicity, and their ability to induce protection in mice. Gel filtration on Sephacryl S-200 yielded 5 major peaks of material while electrophoresis in polyacrylamide gel with sodium dodecyl sulfate revealed a minimum of 28 proteins ranging in MW from 11,000 to 200,000. Analytical isoelectric focusing on acrylamide gel yielded 37 bands of protein, while the periodic acid-Schiff reaction performed on a similar gel revealed 22 glycoproteins. Most proteins were within a pI range of 4.0–7.0, while all of the glycoproteins had pI ranging from 4.0 to 6.5. Immunoelectrophoresis of the S₃ fraction using hyperimmune rabbit serum demonstrated a minimum of 19 precipitin arcs, while crossed immunoelectrophoresis yielded 16 peaks. These determinations were made on several batches of material isolated in the same fashion and gave the same results. Preparative isoelectric focusing yielded 30 fractions. These fractions were assayed for the presence of antigens, then pooled and tested for their ability to induce protection in mice against an oral challenge infection. Fused rocket immunoelectrophoresis of all 30 fractions revealed the presence of a minimum of 18 antigens with pI ranging from 4.0 to 9.0. The pooled fractions (i.e., 1–9; 10–20; 21–30) all protected mice against oral challenge infection, while fraction 5 (pI = 4.3) protected best.