Serum lipids and apolipoproteins and their relationship with macrovascular disease in type 1 diabetes.

In order to examine the relationship between serum lipids and apolipoproteins and macrovascular disease in patients with Type 1 diabetes mellitus, 50 patients with Type 1 diabetes mellitus attending the diabetic clinics at St Mary's and St Charles' Hospitals, London were recruited into a cross-sectional study. B-mode ultrasound was used to measure intima-media thickness and define an arterial ultrasound score for each patient as a non-invasive indicator of atherosclerotic change. Intima-medial (i-m) thickness was significantly higher in those subjects with clinical evidence of macrovascular disease compared to those without macrovascular disease (0.865 +/- 0.191 vs 0.695 +/- 0.162 mm, p = 0.0038). In the study group there were significant correlations between i-m thickness and age (r = 0.65, p < 0.01), total serum cholesterol (r = 0.32, p < 0.01), and serum fibrinogen (r = 0.43, p < 0.01) but no other lipid or apolipoprotein variable. When i-m thickness was corrected for age there were significant correlations with total cholesterol (r = 0.43, p < 0.01) and LDL-cholesterol (r = 0.42, p < 0.01). Whereas total and LDL-cholesterol and serum fibrinogen concentrations were related to the extent of atherosclerotic disease by ultrasound techniques, there was no relationship with high density lipoprotein (HDL) or subfraction cholesterol concentrations. HDL-cholesterol may not be a useful marker for cardiovascular disease in Type 1 diabetes.

The effects of gender and type of diabetes on HDL-cholesterol.

OBJECTIVE: To investigate the influence of gender and type of Diabetes on plasma lipoproteins and post-heparin plasma lipoprotein lipase and hepatic lipase activities. DESIGN AND PATIENTS: Cross sectional study of 22 lean Type 2 diabetic subjects (11 men, 11 women) individually matched for gender, BMI and HbA1 with 22 Type 1 (C-peptide negative) diabetic subjects. MEASUREMENTS: Samples were taken for fasting lipids and post heparin samples were obtained for estimation of post heparin lipolytic activity. RESULTS: In men, HDL-Cholesterol was higher in Type 1 diabetes [1.56 (range 0.97-2.27) vs 1.07 (0.54-1.78) mmol/l, p = 0.009] and this was reflected in both HDL2-cholesterol [0.42 (0.02-1.36) vs 0.22 (0.01-0.90) mmol/l, p = 0.05] and HDL3-cholesterol [1.00 (0.75-1.51) vs 0.72 (0.53-0.87) mmol/l, p = 0.02] subfractions while serum triglyceride concentrations were similar. Lipoprotein lipase activity was higher in men with Type 1 diabetes [16.2 (6.2-42.4) vs 9.77 (5.6-22.6) mmol/h/l, p = 0.02] while hepatic lipase activities were similar [15.7 (9.3-23.0) vs 14.0 (6.8-24.0) mmol/h/l, NS). In women, there were no significant differences between Type 1 and Type 2 diabetes in triglycerides, HDL-C, HDL2 or HDL3. Lipoprotein lipase activity was higher in Type 1 women [19.3 (14.1-35.7) vs 11.0 (7.2-15.2) mmol/h-1 1-1, p = 0.0006] but lipatic lipase activity was also higher [12.1 (4.8-20.5) vs 7.3 (2.3-21.4) mmol/h-1 1-1, p = 0.023]. CONCLUSION: In non-obese diabetic subjects, men with Type 1 diabetes have higher HDL-cholesterol than those with Type 2 diabetes, possibly due to the action of peripheral insulin on lipoprotein lipase activity, while in women, HDL-cholesterol concentrations were similar in Type 1 and Type 2 subjects possibly because of lowered lipatic lipase activity in Type 2 women which offsets the increased lipoprotein lipase activity of the Type 1 women.

Meningitis associated with sulphasalazine in a patient with Sjögren's syndrome and polyarthritis.

A case of meningitis occurring in a 37 year old woman with Sjögren's syndrome, seropositive arthritis, and a possible overlap syndrome soon after starting sulphasalazine and after subsequent rechallenge is reported.

Vestibulocochlear dysfunction in a patient with rheumatoid disease and vasculitis.

The case is described of a patient with rheumatoid disease and evidence of vasculitis who developed acute vestibuloauditory dysfunction resulting in total deafness, which was assumed to be secondary to a vasculitic process affecting the vestibulocochlear nerve. Treatment of the underlying vasculitic process, despite effecting a general improvement of the patient's rheumatoid disease, did not significantly improve the auditory dysfunction.

Leukaemoid reaction and ulcerative colitis.

We describe a patient who presented with a pronounced neutrophil leucocytosis and leukaemoid reaction in association with toxic dilatation of the colon secondary to ulcerative colitis. Although the patient had been previously investigated, the significance of bowel disturbance had not been recognised. Once the inflammatory bowel disease was treated the haematological abnormality subsided.