| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| A randomized study of changes in serum cholesterol, triglycerides, high density lipoproteins, and cortisol during cardiac surgery in patients anaesthetised with propofol-sufentanil vs enflurane-sufentanil. Cardiac Anaesthesia Research Group Hall, R. I., L. Poole, et al. (1990), Can J Anaesth 37(4 Pt 2): S76. |
| A randomized trial of a strategy for increasing high-density lipoprotein cholesterol levels: effects on progression of coronary heart disease and clinical events Whitney, E. J., R. A. Krasuski, et al. (2005), Ann Intern Med 142(2): 95-104. Abstract: BACKGROUND: The high-density lipoprotein (HDL) cholesterol level is a strong predictor of cardiovascular events in epidemiologic studies. Until recently, it has been less extensively studied as a therapeutic target. OBJECTIVE: To assess the angiographic and clinical effects of a pharmacologic strategy to increase HDL cholesterol levels. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from 1993 to 1996. SETTING: Outpatient specialty clinic of a large U.S. military medical center. PARTICIPANTS: 143 military retirees younger than 76 years of age with low HDL cholesterol levels and angiographically evident coronary disease. INTERVENTION: Gemfibrozil, niacin, and cholestyramine or corresponding placebos, with aggressive dietary and lifestyle intervention at baseline. MEASUREMENTS: Change from baseline to 30 months and a composite measure of clinical events that included hospitalization for angina, myocardial infarction, transient ischemic attack and stroke, death, and cardiovascular procedures. RESULTS: At baseline, mean (+/-SD) lipid values were as follows: total cholesterol, 5.1 +/- 0.8 mmol/L (196 +/- 31 mg/dL); low-density lipoprotein (LDL) cholesterol, 3.3 +/- 0.7 mmol/L (128 +/- 27 mg/dL); and HDL cholesterol, 0.9 +/- 0.2 mmol/L (34 +/- 6 mg/dL). Compared with placebo, the pharmacologically treated group experienced a 20% (95% CI, 14.8% to 24.3%) decrease in total cholesterol level, a 36% (CI, 28.4% to 43.5%) increase in HDL cholesterol level, a 26% (CI, 19.1% to 33.7%) decrease in LDL cholesterol level, and a 50% (CI, 40.5% to 59.2%) reduction in triglyceride levels. Focal coronary stenosis increased by 1.4% in the placebo group but decreased by 0.8% in the drug group (difference, -2.2 percentage points CI, -4.2 to -0.1 percentage points). A composite cardiovascular event end point was reached in 26% of patients in the placebo group and 13% of those in the drug group (difference, 13.7 percentage points CI, 0.9 to 26.5 percentage points). Side effects, particularly flushing and gastrointestinal intolerance, were more common in the drug group but rarely led to withdrawal from the study. Limitations: The study was small and used a composite clinical outcome. Whether improvements in angiographic findings were due to reductions in LDL cholesterol or increases in HDL cholesterol was not established. Flushing may have led to inadvertent unblinding in patients who were randomly assigned to active study drugs. CONCLUSIONS: A combination regimen aimed at increasing HDL cholesterol levels improves cholesterol profiles, helps prevent angiographic progression of coronary stenosis, and may prevent cardiovascular events in some people who exercise regularly and eat low-fat diets. |
| A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP) Tsuyuki, R. T., J. A. Johnson, et al. (2002), Arch Intern Med 162(10): 1149-55. Abstract: BACKGROUND: Despite clear evidence for the efficacy of lowering cholesterol levels, there is a deficiency in its real-world application. There is a need to explore alternative strategies to address this important public health problem. This study aimed to determine the effect of a program of community pharmacist intervention on the process of cholesterol risk management in patients at high risk for cardiovascular events. METHODS: A randomized controlled trial conducted in 54 community pharmacies (1998-2000) included patients at high risk for cardiovascular events (with atherosclerotic disease or diabetes mellitus with another risk factor). Patients randomized to pharmacist intervention received education and a brochure on risk factors, point-of-care cholesterol measurement, referral to their physician, and regular follow-up for 16 weeks. Pharmacists faxed a simple form to the primary care physician identifying risk factors and any suggestions. Usual care patients received the same brochure and general advice only, with minimal follow-up. The primary end point was a composite of performance of a fasting cholesterol panel by the physician or addition or increase in dose of cholesterol-lowering medication. RESULTS: The external monitoring committee recommended early study termination owing to benefit. Of the 675 patients enrolled, approximately 40% were women, and the average age was 64 years. The primary end point was reached in 57% of intervention patients vs 31% in usual care (odds ratio, 3.0; 95% confidence interval, 2.2-4.1; P<.001). CONCLUSIONS: A community-based intervention program improved the process of cholesterol management in high-risk patients. This program demonstrates the value of community pharmacists working in collaboration with patients and physicians. |
| A randomized trial of the IMPACT worksite cholesterol reduction program Fielding, J. E., T. Mason, et al. (1995), Am J Prev Med 11(2): 120-3. Abstract: To evaluate the incremental effectiveness of a worksite cholesterol control management program when added to an established, comprehensive health promotion program at the worksite, we conducted a randomized, controlled trial including both blue- and white-collar employees at four geographically dispersed worksites. One hundred twenty-seven employees with serum cholesterol levels of 240 mg/dL or greater were assigned to receive an enhanced intervention program (the IMPACT program) while 125 were assigned to a regular screening and referral group, which included a comprehensive worksite health promotion program. One hundred eighteen program and 116 control subjects had one-year follow-up measures recorded. We used venipuncture specimens to obtain standardized baseline and follow-up cholesterol measures. Program subjects experienced a mean decline of 16.6 mg/dL as compared to a decline of 10.0 mg/dL in control subjects. The crude intergroup difference was 6.6 mg/dL (95% confidence internal CI = 1.1, 14.3), while the adjusted difference was 6.9 mg/dL (95% CI = 0.5, 14.3). Neither difference was significant at the.05 level. The percentage of program subjects who reduced their cholesterol level to below 240 mg/dL (36%) was significantly greater than the corresponding percentage among control subjects (21%). The enhanced worksite cholesterol control program provided incremental benefit in the percentage of individuals with elevated cholesterol in a population already exposed to a comprehensive worksite health promotion program that includes regular cholesterol screening, referral, and education activities. |
| A randomized trial to assess effectiveness and cost in clinical practice: rationale and design of the Cholesterol Reduction Intervention Study (CRIS) Oster, G., G. M. Borok, et al. (1995), Control Clin Trials 16(1): 3-16. Abstract: To compare the effectiveness and costs of two alternative approaches to the treatment of hypercholesterolemia, a prospective randomized trial is being undertaken at Southern California Kaiser Permanente, a large health maintenance organization. Six hundred and twelve patients with postdiet LDL cholesterol (LDL-C) levels in the range of 190-230 mg/dl (or 160-230 mg/dl for those with coronary heart disease or two or more coronary risk factors) were randomized to a stepped-care regimen (initial treatment with niacin followed by other agents if needed) or to initial use of lovastatin, an HMG-CoA reductase inhibitor. All patients are being followed for 1 year. The study seeks to approximate conditions of typical clinical practice: provider compliance with these plans of treatment is encouraged but not enforced and patients pay for medication as they customarily would. Principal outcomes of interest include the proportion of participants who achieve goal LDL-C at one year, the mean change in total cholesterol and LDL-C levels between baseline and the end of follow-up, and the costs of cholesterol-lowering therapy. |
| A randomized, double-blind, placebo-controlled, 8-week study to evaluate the efficacy and safety of once daily atorvastatin (10 mg) in patients with elevated LDL-cholesterol Wang, K. Y. and C. T. Ting (2001), Jpn Heart J 42(6): 725-38. Abstract: Lowering of serum cholesterol levels by pharmacologic intervention with statins reduces the incidence of cardiovascular events in subjects with and without atherosclerotic manifestations. In an 8-week, randomized, double-blind study we compared the efficacy and safety of the new compound atorvastatin for reducing LDL-cholesterol (LDL-C) with placebo in an Asian patient cohort. Patients with LDL-C between 160 mg/dl and 250 mg/dl were randomly assigned to treatment with 10 mg atorvastatin or placebo once daily for 8 weeks. At the end of weeks 4 and 8 of the randomized phase, the serum concentrations of lipid parameters as well as safety parameters were determined. Fifty-four patients (32 males and 22 females) were enrolled. Twenty-six patients were assigned to the treatment group. The primary end-point, LDL-C, was reduced by 40% and 42% after 4 and 8 weeks of treatment in the atorvastatin treated patients (p<0.001). The reductions in total cholesterol and triglycerides were up to 31% and 23%, respectively. The HDL-C levels increased up to 11% (p=0.043). There were no significant adverse events. Transient increases in CPK levels (10 times) without myalgia were identified in 1 patient. Atorvastatin, 10 mg/day produced significant reductions in LDL-C, total cholesterol and triglycerides and an elevation of HDL-C levels when used as an adjunct to diet in hyperlipidemic patients. The majority of the clinical effects could be attained by week 4. The overall safety profile of atorvastatin was similar to that of placebo. Atorvastatin was considered to be well tolerated in this patient cohort. |
| A rapid and sensitive method for HPLC cholesterol determination in bile Bocos, C., M. Castro, et al. (1992), Rev Esp Fisiol 48(3): 211-4. Abstract: A relatively little time consuming simple method based on the treatment of bile with cholesterol oxidase and subsequent high performance liquid chromatography measurement of the 3-ketocholesterol produced in order to determine the level of the cholesterol concentration is described. The method avoids bilirubin interferences, has high reproducibility and recovery assays give 100% values. It is highly sensitive and suitable for use in the determination of cholesterol concentrations in bile and other bilirubin containing biological fluids. |
| A rapid and sensitive micro-assay for the enzymatic determination of plasma and lipoprotein cholesterol Auerbach, B. J., J. S. Parks, et al. (1990), J Lipid Res 31(4): 738-42. Abstract: A rapid and inexpensive micro-assay for determining cholesterol in plasma and isolated lipoprotein fractions has been established which utilizes a commercially available enzymatic reagent with semi-automated instruments and microtiter plates. The assay is sensitive, precise, and easy to perform. The color development is linear from 0.4 to 20 micrograms cholesterol/well, with sample volumes of 2 to 100 microliters. Inter- and intra-assay variability yielded coefficients of variation (CV) of 2.75% (n = 51) and 1.09% (n = 32), respectively. The concentrations of total plasma and lipoprotein cholesterol (d greater than 1.006 g/ml) obtained with this method were compared with those analyzed in a lipid laboratory standardized to the Centers for Disease Control. The correlation coefficients between the two methods were 0.976 and 0.964, respectively. For total high density lipoprotein (HDL) and the HDL3 subfraction, inter-assay variability was 4.12% and 6.33% (n = 27), respectively; the intra-assay variability was 2.79% and 4.19% (n = 12). |
| A rapid isocratic high-performance liquid chromatography method for determination of cholesterol and 1,2-dioleoyl-sn-glycero-3-phosphocholine in liposome-based drug formulations Singh, R., M. Ajagbe, et al. (2005), J Chromatogr A 1073(1-2): 347-53. Abstract: A high-performance liquid chromatography (HPLC) method for the determination of cholesterol and 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) in liposome-based drug formulations has been developed. Liposome formulations of anticancer agents (viz., paclitaxel, docetaxel, 7-ethyl-10-hydroxycamptothecin (SN38), doxorubicin, mitoxantrone and an antisense oligodeoxyribonucleotide, etc.) were prepared. These formulations contain DOPC, cholesterol and other lipids, such as tetramyristoyl cardiolipin or 1,3-bis(1,2-bis-tetradecyloxy-propyl-3-dimethylethoxyammonium bromide)propan-2-ol (R)-PCL-2 in product-specific ratios. A simple HPLC method that uses isocratic elution and UV detection has been developed for simultaneous quantification of cholesterol and DOPC components of the liposome formulations. The chromatographic separation of these components is achieved using a C8 analytical column with 50 mM ammonium phosphate buffer (pH 2.7)-methanol (15:85, v/v) as mobile phase. Both cholesterol and DOPC peaks are well resolved and free of interference from other excipients or degraded impurities in the formulation. The method has been found to be linear (r > 0.999) over a wide concentration range of both analytes. This method offers the advantage of simultaneous quantitation of cholesterol and DOPC in various liposome-based formulations without any preprocessing of the sample, and has quantitation limits of 0.5 and 10 microg/mL for cholesterol and DOPC, respectively. |
| A rapid method for the measurement of cholesterol thermodynamic activity in bile salt-lecithin-cholesterol solutions Jain, U. K., W. I. Higuchi, et al. (1993), J Pharm Sci 82(7): 714-20. Abstract: Earlier work from this laboratory suggested that the cholesterol (Ch) thermodynamic activity is a more meaningful measure of the degree of Ch supersaturation in human bile than the widely known cholesterol saturation index. An early version of a method for determining thermodynamic activity based on Ch uptake from bile salt (BS)-lecithin (LE) solutions into silicone polymer particles, but requiring 12-24 h for reaching equilibrium, was considered unsatisfactory because Ch nucleation and crystal formation frequently occurred within a few hours. The aim of the present work was to develop a method that would reduce equilibration times to the order of 1 h. Changing the thickness of the silicone film alone did not result in the desired reduction of equilibration times and it was soon deduced that the uptake of Ch by the silicone film from the BS-LE solution was a surface-controlled transport process involving the transport of Ch by negatively charged BS and BS-LE micelles at the interface. Three different approaches were tried to modify the silicone film to make its surface positively charged, thereby reducing and/or eliminating the presumed electrical repulsion barrier for the interfacial transport of Ch. The film was treated with different concentrations of aminopropyl methyl-dimethylsiloxane (AMDS) in cyclohexane, octadecyldimethyl-3-(trimethoxysilyl)-propyl ammonium chloride (ODTOP) in methanol, and octadecylamine solution in ethanol. Films treated with 1-1.5% ODTOP and 5-10% AMDS reduced the Ch equilibration times for model BS-LE solutions to < 1 h. |
| A rapid screening procedure for cholesterol and dehydrocholesterol by electrospray ionization tandem mass spectrometry Johnson, D. W., H. J. ten Brink, et al. (2001), J Lipid Res 42(10): 1699-705. Abstract: The mono-(dimethylaminoethyl) succinyl (MDMAES) ester is a new derivative for rapid, mild, and sensitive electrospray ionization tandem mass spectrometry (ESI-MS/MS) analysis of cholesterol and dehydrocholesterol. It is an order of magnitude more sensitive than the previous most practical alternative, the N-methylpyridyl ether derivative. The MDMAES derivative was used to develop a rapid screening procedure for the biochemical diagnosis of Smith-Lemli-Opitz syndrome (SLOS) by measuring the dehydrocholesterol/cholesterol ratio in plasma (5 microl) and plasma spotted onto filter paper. Details of the synthesis of 25,26,26,26,27,27,27-(2)H7-7-dehydrocholesterol, used as a standard for quantitation, are included. The measurement of total sterols as MDMAES esters, after base hydrolysis of plasma, afforded a dehydrocholesterol/cholesterol ratio of 0.05-2.95 for SLOS patient samples (n = 5) compared with 0.001-0.003 for normal adult controls (n = 20). Direct hexane extraction of plasma without base hydrolysis enabled the measurement of free sterols with a total sample analysis time of <1 h. The free dehydrocholesterol/cholesterol ratio was 0.10-4.47 for SLOS patient samples (n = 5) and 0.003-0.011 for normal adult controls (n = 20). |
| A rapid single-step centrifugation method for determination of HDL, LDL, and VLDL cholesterol, and TG, and identification of predominant LDL subclass Sawle, A., M. K. Higgins, et al. (2002), J Lipid Res 43(2): 335-43. Abstract: Determination of the circulating levels of plasma lipoproteins HDL, LDL, and VLDL is critical in the assessment of risk of coronary heart disease. More recently it has become apparent that the LDL subclass pattern is a further important diagnostic parameter. The reference method for separation of plasma lipoproteins is ultracentrifugation. However, current methods often involve prolonged centrifugation steps and use high salt concentrations, which can modify the lipoprotein structure and must be removed before further analysis. To overcome these problems we have now investigated the use of rapid self-generating gradients of iodixanol for separation and analysis of plasma lipoproteins. A protocol is presented in which HDL, LDL, and VLDL, characterized by electron microscopy and agarose gel electophoresis, separate in three bands in a 2.5 h centrifugation step. Recoveries of cholesterol and TG from the gradients were close to 100%. The distribution profiles of cholesterol and TG in the gradient were used to calculate the concentrations of individual lipoprotein classes. The values correlated with those obtained using commercial kits for HDL and LDL cholesterol. The position of the LDL peak in the gradient and its shape varied between plasma samples and was indicative of the density of the predominant LDL class. The novel protocol offers a rapid, reproducible and accurate single-step centrifugation method for the determination of HDL, LDL, and VLDL cholesterol, and TG, and identification of LDL subclass pattern. |
| A rapid, simple high capacity cholesterol crystal growth assay Harvey, P. R. and G. A. Upadhya (1995), J Lipid Res 36(9): 2054-8. Abstract: Cholesterol crystal "nucleation time", more recently referred to as cholesterol crystal observation time, is defined as the first appearance of cholesterol crystals from isotropic crystal-free biles on light microscopy. This test is used to assess the potency of nucleating agents. Crystal appearance has conventionally been determined by polarizing light microscopy and crystal growth by counting the number of crystals. In this study we adapted a spectrophotometric method to a microtiter plate reader to generate cholesterol crystal growth curves. Model biles were prepared with a cholesterol saturation of 1.2 to 1.3 and total lipid concentration of 10.7 g/dl (taurocholate, 125 mM; cholesterol, 16.8-18.4 mM; phospholipid, 43 mM). Pronucleating IgM samples were used to establish and validate the assay. Cholesterol crystal growth curves were generated by reading absorption at 630 nm daily on a Dynatech microplate reader. Results were correlated to cholesterol crystal counts as determined by polarizing light microscopy. Standard curves generated from absorbencies of known masses of cholesterol crystals were used to quantify the mass of cholesterol crystals formed over the observation period. The assay was applied to known pronucleating biliary immunoglobulins. Results obtained were similar to our previous report that biliary IgM is more potent than biliary IgG. We conclude that using microplates and a microtiter plate reader provides a rapid high capacity method for detecting cholesterol crystal growth to assess potential nucleating agents in nucleation assays. |
| A recombinant bovine gallbladder mucin polypeptide binds biliary lipids and accelerates cholesterol crystal appearance time Nunes, D. P., N. H. Afdhal, et al. (1999), Gastroenterology 116(4): 936-42. Abstract: BACKGROUND & AIMS: Mucin has a central role in the pathogenesis of cholesterol gallstones, in part because of its ability to bind biliary lipids and accelerate cholesterol crystal appearance time. Previous studies have localized these properties to nonglycosylated mucin domains, and we have recently shown that these domains contain a series of 127-amino acid, cysteine-rich repeats. The aim of this study was to express a recombinant mucin polypeptide containing these repeats and investigate its lipid-binding and pronucleating properties. METHODS: A recombinant mucin polypeptide was expressed as a glutathione S-transferase fusion protein in Escherichia coli, purified by affinity chromatography, and compared with native bovine gallbladder mucin in lipid-binding and cholesterol crystal appearance time assays. RESULTS: The recombinant mucin polypeptide bound a hydrophobic fluorescent probe and cholesterol in a concentration-dependent manner. It accelerated the appearance of cholesterol crystals from lithogenic model bile, an effect that was both time and concentration dependent. CONCLUSIONS: The cysteine-rich repeats in the recombinant mucin polypeptide correspond to the protease-sensitive hydrophobic domains identified in earlier biochemical studies. Further delineation of the lipid-binding site(s) in these repeats will provide new insights into the mechanism of cholesterol crystal nucleation and stone growth. |
| A reference method laboratory network for cholesterol: a model for standardization and improvement of clinical laboratory measurements Myers, G. L., M. M. Kimberly, et al. (2000), Clin Chem 46(11): 1762-72. Abstract: BACKGROUND: Accurate and precise measurement of blood cholesterol plays a central role in the National Cholesterol Education Program's strategy to reduce the morbidity and mortality attributable to coronary heart disease. Matrix effects hamper the ability of manufacturers to adequately calibrate and validate traceability to the National Reference System for Cholesterol (NRS/CHOL). CDC created the Cholesterol Reference Method Laboratory Network (CRMLN) to improve cholesterol measurement by assisting manufacturers of in vitro diagnostic products with validation of the traceability of their assays to the NRS/CHOL. METHODS: CRMLN laboratories established the CDC cholesterol reference method (modification of the Abell-Levy-Brodie-Kendall chemical method) and are standardized using CDC frozen serum reference materials. CRMLN laboratories use common quality-control materials and participate in monthly external performance evaluations conducted by CDC. The CRMLN performance criteria require member laboratories to agree with CDC within +/-1.0% and maintain a CV < or =2.0%. RESULTS: From 1995 to 200 the CRMLN laboratories met the accuracy criterion 97% of the time and the precision criterion 99% of the time. During this time period, the CRMLN maintained an average bias to CDC of 0.01% and an average collective CV of 0.33%. CONCLUSIONS: CDC established the CRMLN as the first international reference method laboratory network. The CRMLN assists manufacturers in the validation of the calibration of their diagnostic products so that clinical laboratories can measure blood cholesterol more reliably. The CRMLN can serve as a model for other clinical analytes where traceability to a hierarchy of methods is needed and matrix effects of the field methods with processed calibrators or reference materials are present. |
| A relationship between aortic stiffness and serum HDL3 cholesterol concentrations in hypercholesterolaemic, symptom-free men. The PCVMETRA Group (Groupe de Prevention Cardiovasculaire en Medecine du Travail) Giral, P., V. Atger, et al. (1994), J Cardiovasc Risk 1(1): 53-8. Abstract: OBJECTIVE: We set out to evaluate the relationship between aortic stiffness and serum lipids and lipoprotein fractions, including high-density-lipoprotein (HDL) cholesterol subfractions. METHODS: One hundred and five asymptomatic, normotensive, untreated, hypercholesterolaemic men underwent measurement of aortic pulse-wave velocity (PWV) by mecanography and assay of total cholesterol, triglycerides, HDL cholesterol and its subfractions (HDL2 cholesterol and HDL3 cholesterol), determined by electrophoresis. RESULTS: PWV was related to HDL cholesterol (r = 0.21, p = 0.05) and more specifically to HDL3 cholesterol subfraction (r = 0.29, p < 0.01). The latter association remained significant after adjustment for systolic blood pressure and age. Multivariate analysis demonstrated an independent association of PWV (r2 = 0.27, P < 0.001) with age, systolic blood pressure and HDL3 cholesterol. CONCLUSION: Although hypercholesterolaemia was not accompanied by increased aortic rigidity, there was a positive relationship between PWV and HDL cholesterol and between PWV and HDL3 cholesterol independently of the influence of age and systolic blood pressure on PWV. These results suggest that, in hypercholesterolaemic men, HDL3 could, in addition to its anti-atherogenic property, have a prosclerotic stiffening effect. This duality could explain why, in clinical studies, although the level of the HDL2 subfraction is frequently associated with a lower incidence of coronary artery disease, results for the HDL3 subfraction are less convincing and remain equivocal. |
| A remarkable increase in high-density lipoprotein-cholesterol by alcohol intake in a homozygous patient with cholesteryl ester transfer protein deficiency Nishiwaki, M., T. Ishikawa, et al. (1995), Ann N Y Acad Sci 748: 626-9. |
| A retrospective assessment of the effectiveness of fenofibrate 267 mg on high-density lipoprotein cholesterol levels in patients attending a lipid clinic le Roux, C. W., E. Murphy, et al. (2002), Clin Ther 24(7): 1154-60. Abstract: BACKGROUND: A high-density lipoprotein cholesterol level (HDL-C) <1 mmol/L is associated with increased cardiovascular morbidity and mortality. In clinical trials, fibrates have been shown to increase levels of HDL-C, with subsequent reduction in cardiovascular risk. OBJECTIVE: This study evaluated the use of fenofibrate 267 mg/d in a routine lipid clinic setting to determine how much HDL-C could be increased in everyday clinical practice. METHODS: Blood samples from patients who had taken fenofibrate 267 mg/d between 1998 and 2001 at the Lipid Clinic, Charing Cross Hospital, London, United Kingdom, were analyzed for changes in total cholesterol (TC), HDL-C, and triglycerides during follow-up. Results: Sixty-five consecutive patients (49 men, 16 women; mean age, 54 +/- 1.2 years) were included in the study. The follow-up period ranged from 1 to 36 months (mean, 9.6 months +/- 26.7 days). Patients achieved a 6% overall increase in HDL-C, from 0.91 +/- 0.03 mmol/L to 0.97 +/- 0.03 mmol/L (P = 0.016). The TC/HDL-C ratio decreased by 21% from 7.0 +/- 0.3 mmol/L to 5.5 +/- 0.2 mmol/L (P < 0.001). Patients with lower levels of HDL-C at baseline (<0.9 mmol/L) showed the most improvement, with an 8% increase (P < 0.05). Twenty-eight patients (43%) reached a target HDL-C posttherapy value >1.0 mmol/L. Thirty-nine patients (responders) had increases in their HDL-C levels; 26 patients (nonresponders) had decreases or no change in their HDL-C levels. For the 26 (40%) patients in whom HDL-C did not increase, the TC/HDL-C ratio decreased by 12% from 6.5 +/- 0.3 mmol/L to 5.7 +/- 0.3 mmol/L (P = 0.003). CONCLUSIONS: Fenofibrate 267 mg/d is well tolerated and can achieve significant increases in HDL-C levels in clinical practice. However, these results should be confirmed in a larger routine clinical setting because of the discrepancies between the results of some clinical trials. |
| A retrospective study on cholesteatoma otitis media coexisted with cholesterol granuloma Gong, S., G. Bai, et al. (2001), Zhonghua Er Bi Yan Hou Ke Za Zhi 36(4): 289-91. Abstract: OBJECTIVE: To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma. METHODS: Sixty three cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were verified by surgery and pathology. Fifteen cases of cholesteatoma coexisted with cholesterol granuloma were found among the 63 patients. RESULTS: All fifteen cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the ear drum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternatively, and the latter lied mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposition of horizontal segment of facial nerve and tegmen of attic were found. Occlusion of Eustachian tube was found in 6 cases, and occlusion of tympanic isthmus was found in all cases. A post-operative dry ear was obtained, and hearing improved in all 12 cases following tympanoplasty. CONCLUSIONS: Cholesteatoma and cholesteatoma granuloma in middle ear may share a common pathophysiological etiology, an occlusion of ventilation and a disturbance of drainage. The diagnosis should be considered when patients with chronic otitis media presented with bloody otorrhea. CT and magnetic resonance imaging(MRI) are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion, and the principle of surgery is to clear the lesion and create an adequate drainage. |
| A retrospective study on cholesteatoma otitis media coexisting with cholesterol granuloma Luo, L., S. Gong, et al. (2002), J Huazhong Univ Sci Technolog Med Sci 22(2): 168-70. Abstract: To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage. |