Plasma apolipoprotein L concentrations correlate with plasma triglycerides and cholesterol levels in normolipidemic, hyperlipidemic, and diabetic subjects.

Apolipoprotein L is a newly recognized component of human plasma lipoproteins. Mainly associated with apoA-I-containing lipoproteins, it is a marker of distinct HDL subpopulations. In an effort to gain inference as to its as yet unknown function, we studied biological determinants of apoL levels in human plasma. The distribution of apoL in normal subjects is asymmetric, with marked skewing toward higher values. No difference was found in apoL concentrations between males and females, but we observed an elevation of apoL in primary hypercholesterolemia (10.1 vs. 8.5 microgram/mL in control), in endogenous hypertriglyceridemia (13.8 microgram/mL, P < 0.001), combined hyperlipidemia phenotype (18.7 g/mL, P < 0.0001), and in patients with type II diabetes (16.2 microgram/mL, P < 0.02) who were hyperlipidemic. Significant positive correlations were observed between apoL and the log of plasma triglycerides in normolipidemia (0.446, P < 0.0001), endogenous hypertriglyceridemia (0.435, P < 0.01), primary hypercholesterolemia (0.66, P < 0.02), combined hyperlipidemia (0.396, P < 0.04), hypo-alphalipoproteinemia (0.701, P < 0.005), and type II diabetes with hyperlipidemia (0.602, P < 0. 01). Apolipoprotein L levels were also correlated with total cholesterol in normolipidemia (0.257, P < 0.004), endogenous hypertriglyceridemia (0.446, P = 0.001), and non-insulin-dependent diabetes mellitus (NIDDM) (0.548, P < 0.02). No significant correlation was found between apoL and body mass index, age, sex, HDL-cholesterol or fasting glucose and glycohemoglobin levels. ApoL levels in plasma of patients with primary cholesteryl ester transfer protein deficiency significantly increased (7.1 +/- 0.5 vs. 5.47 +/- 0.27, P < 0.006).

The influence of psychological factors on chest pain associated with myocardial infarction.

This paper will discuss some of the effects that psychological factors have on chest pain during and following myocardial infarction: 1. Psychological factors and the development of a myocardial infarction; a) the relationships of personality and other high risk factors, b) the onset situation of hopelessness and helplessness, c) immediate psychological precipitants (fact and fantasy), d)denial and delay. 2. Psychological factors during recovery; a)problems associated with the Type A personality, b) critical periods, c)absence of angina and denial, d) the effect of post M.I. angina, e) co-existence of angina and psychogenic pain. 3. How reaction of the marital partner can affect the patient and his experience of pain. 4. Factors which tend to minimize psychogenic invalidism.

Utilization review expanded into quality assurance program.

An Army hospital was able to broaden and refine its extensive utilizaiton review efforts to establish a comprehensive quality assurance program that complies with JCAH standards.

Postural hypotension and mental function in the elderly.

The effect of 3 hours of ambulatory activity on the mental function of 12 elderly persons with postural hypotension was examined. There was little difference between the mean combined mental status and set test scores when the subjects were supine (42.3) and when they were erect after 3 hours of ambulatory activity (42.2). A control group of persons of similar age and health who did not have hypotension also exhibited little difference in mean scores (49.9 v. 51.5 respectively). The mean scores of the two groups of subjects did not differ significantly. After 6 months the mean scores of the two groups were 40.9 and 44.7 respectively. It appears that elderly individuals with postural hypotension do not exhibit any appreciable deterioration in mental function with ambulation or after a 6-month period.

Postural hypotension and diuretic therapy in the elderly.

Blood pressures were recorded in 319 ambulatory subjects, largely men, age 50 to 99 years. The mean systolic pressures were maximal in the seventh and eighth decades (136.0 and 132.1 mm Hg with the subjects supine and erect, respectively), whereas the mean diastolic pressures fell progressively after age 69. The distribution of postural changes in mean blood pressure was similar in each decade; a decrease of 20 mm Hg on more was noted in 3.4% of the subjects aged 80 to 99 years and in 4.1% of those aged 50 to 79 years. The frequency of postural hypotension was 4.6% in subjects treated with diuretics and 3.4% in those not so treated. Blood pressures and the frequency of postural hypotension did not progressively increase in age in this elderly population.