205 methodS indicates that invasive tumour growth will occur within five years of the first biopsy in 70% of infertile men with this germ-cell pattern (see figure). Proper management of patients with this germ-cell pattern seems crucial. Our practice is to observe patients with atypical germ cells carefully by three-monthly physical examinations, and
A similar practice has been recommended by others.6 However, with our latest data on invasive tumour growth we believe that an infertile man should be advised to have a testis with carcinoma-in-situ removed as soon as the diagnosis has been made. Some germ:ell carcinomas are very malignant. Pugh and Cameron9 found a three-year corrected survival-rate of 47% in teratoma pa-
including palpation
ing on the back of the throat. Though Smith was subsequently hanged, he probably deserves some posthumous recognition for this use of the naso-trigemino- vagal reflex. Clinical School, Royal Prince Alfred Hospital, Camperdown, N.S.W., Australia.
PETER ROOT
orchidometry.
CEREBRAL INFARCTION AND MYOCARDIAL INFARCTION
SIR,-I agree with you’ that insufficient attention has been
SiR,—J can confirm that mouth-to-mouth breathing can be lifesaving in acute epiglottitis. io A boy aged 20 months with acute epiglottitis ceased breathing in my presence. The
to the profound differences in epidemiological characteristics between myocardial infarction and cerebral infarction. However, I was surprised to see that you base this opinion to a large extent on changes in routine mortality statistics. For cerebral infarction such statistics are hopelessly compromised by changing terminology and by the widespread (but variable) use of non-specific terms such as stroke and cerebrovascular accident. Detailed study of original death certificates and necropsy records reveals that there has been virtually no change in the death-rate from cerebrovascular disease since 1901, and that both the sex ratio and the relative contribution of cerebral infarction have also been remarkably stable.2 By contrast, the male (but not the female) death-rate from myocardial infarction has increased greatly since the early
obstruction was so severe that it prevented both inspiration and expiration. After I had inflated the lungs by mouth-tomouth breathing, I had to compress the chest to expel the air again. An interesting feature was that when an oxygen mask was used the boy then had the strength to breathe spontaneously, but breathing failed again when the mask was removed. He reached hospital alive and was successfully treated by intubation followed by tracheostomy. A throat swab
The anomalous behaviour of the male death-rate from myocardial infarction is clearly seen in the accompanying figure. In the census year of 1921 male and female death rates showed similar age-specific slopes for both ischaamic heart-disease and total cerebrovascular disease. Fifty years later, in 1971, there had been very little change except in the male heart-disease rates, which had increased several-fold, especially at younger
yielded group-A haemolytic streptococci.
ages. These observations do
tients. Laboratory of Reproductive Biology and Fertility Clinic, Department of Obstetrics and Gynæcology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
NIELS E. SKAKKEBÆK JØRGEN G. BERTHELSEN
ACUTE EPIGLOTTITIS
71 Victoria Road, Oulton Broad, Lowestoft NR33 9LW
N. B. EASTWOOD
DANGEROUS NASAL REFLEXES
paid
1920s.3-6
not
necessarily challenge,
as
your edi-
1. 2.
Lancet, 1978, i, 1239. Anderson, T. W., MacKay, J. S. ibid, 1968, i, 1137. 3. Anderson, T. W., le Riche, W. H. Br. J. prev. soc. Med., 1970, 24, 1. 4. Anderson, T. W. Can. med.Ass.J. 1973,108, 1500. 5. Anderson, T. W. Lancet, 1973, ii, 298. 6. Anderson, T. W. New Scientist, 1978, 77, 374.
reflexes from the nose"I calls to mind the case of the murderer George Joseph Smith. 12 A polygamist who made off with his brides’ savings within days of marriage, Smith in 1910 married a Beatrice Munday whose considerable private means he soon discovered were in the hands of trustees. On July 9, 1911, having prevailed upon his "wife" to make out her will in his favour, he bought a cheap iron bathtub for their home and then visited a local doctor for a prescription for his wife’s "fits". Three visits by the doctor found the doomed lady complaining of no more than headache, nevertheless on July 13 he was summoned to find her lying supine and dead in the bathwater after a "fit". Fifteen months later another "wife" was found in identical circumstances in his Blackpool domestic bathtub. Overconfident now, his next wife died in her bath in London a mere three weeks later. The second victim’s father, still mourning, noticed the report in a newspaper and contacted the police. By June, 1915, Smith was on trial. Sir Bernard Spilsbury, for the prosecution, was able to demonstrate (having almost killed a policeman’s daughter who volunteered to be a guineapig) that if the legs of a person lying in a bath were suddenly jerked upwards, the resultant immersion of the head could cause a cardiac arrest, which he attributed to the pressure of water suddenly imping-
SIR,-Allison’s letter
8. 9.
on
dangerous
Hill, A. B. A Short Textbook of Medical Statistics. London, 1977 Pugh, R. C. B., Cameron, K. M. in Pathology of the Testis (edited by R. C. B. Pugh); p. 199. Oxford, 1976.
10. Lancet, 1978,i, 1294. 11. Allison, D J. Lancet, 1977, i, 909. 12. Camps, F. E Barber, R. The Investigation of Murder;
p. 78. London, 1966.
Age-specific death rates from cerebrovascular and isehsemic heart-disease, England and Wales, 1921 and 1971. Vertical scale is logarithmic, and horizontal (age) scale for cerebrovascular disease is shifted to right to avoid overlapping of lines.
206 torial suggests, the concept that cerebral infarction and myocardial infarction share a similar underlying xtiology (atherosclerosis). Rather, they challenge the simplistic idea that both are the automatic end-result of a single pathological process. This is particularly true in the case of the modern male epidemic of myocardial infarction, a large part of which could well be the result of an increase in the vulnerability of the myocardium to an inadequate blood-supply rather than a change in the prevalence of disease of the coronary arteries. Department of Preventive Medicine and Biostatistics,
University of Toronto, Toronto, Canada M5S 1A8
TERENCE W. ANDERSON
H.D.L. CHOLESTEROL IN DIABETES MELLITUS
SiR,—Iwas unable
to
agree with all the conclusions of Dr
Calvert and his
colleagues (July 8, p. 66). Before differences serum-high-density-lipoprotein (H.D.L.) cholesterol concen-
in trations in diabetic and normal men and women can be attributed to the diabetes per se, other factors which influence serum H.D.L.-cholesterol concentration and which may differ between different populations must be taken into account. Alcohol intake,I-3 for example, is likely to vary between diabetics who are on carbohydrate-restricted diets and normal controls, especially when these are recruited from the Armed Forces where heavy drinking is traditional. Calvert et al. provide information about body-weight, but it is not body-weight, but obesity which influences serum H.D.L.-cholesterol.4 Thus, weight should have been expressed as body-mass index or percentage of ideal weight so that allowance for height was made.5 The concentrations of serum cholesterol6,7 and triglycerides8 and number of cigarettes smoked,9 all of which influence serum H.D.L.-cholesterol levels, were not included in the paper. The conclusion that sulphonylureas might influence serum-H.D.L. cholesterol is not justified by the study since the groups receiving different therapies were matched only for age, weight, and HbA,. Indeed, the matching for weight does not seem to have been very precise since the S.E.M. for the weight of the sulphonylurea-treated group was very different from that of the other two groups. There was no matching for height, alcohol intake, or serum-lipid concentrations. Perhaps even more important, the treatment which patients were receiving had not been chosen at random, but presumably on the basis of clinical indications. Thus, the patients in each group did not differ solely in their treatment, but also in the degree and type of their diabetes. In another study in which the effect of starting treatment with chlorpropamide was examined there was an increase in serum H.D.L.-cholesterol concentration sustained over one year. 10 In the report by Lopes-Virella and othersl’ cited by Calvert and co-workers, it was concluded that patients with diabetes have lower than normal serum H.D.L.-cholesterol levels. However, their normal controls were unusual in that the distribution of their serum H.D.L.-cholesterol concentrations was positively skewed, despite which Student’s t test was used to compare them with diabetics. I have lately completed a study in which diabetic patients treated with insulin were found to have higher serum H.D.L.1. 2.
Castelli, W. P., and others. Lancet, 1977,
ii,
153.
cholesterol concentrations than normal men and women or diabetics not receiving insulin. The results are still being analysed but differences of the kind which I have discussed are emerging. Non-insulin-dependent diabetics are the most obese and have higher serum M-particle concentrations than the other two groups. They also have the lowest alcohol consumption, the normal group drinking the most alcohol. The heparin-MnCl2 method for estimating serum H.D.L.cholesterol was used in my study. This method gives higher H.D.L.-cholesterol levels than the phosphotungstate-MgCl2 method used by Calvert et al. and Lopes-Virella et al. This is probably because some H.D.L. is precipitated in the phosphotungstate-MgCl2 method, whereas with the heparin-MnCl2 method there may be some incomplete precipitation of H.D.L., and the apolipoprotein-B-containing lipoproteins. In my study the apolipoprotein-B concentration of the supernatants was determined by radioimmunoassay’2 and incomplete precipitation was not found to explain the differences in serum H.D.L.cholesterol observed. Fuller et al.’ found that serum H.D.L.cholesterol levels were highest in those non-diabetic local-government employees with the highest blood-glucose levels and Nikkila has recently reported results in diabetics similar to mine." At present, the most appropriate conclusion from all these studies seems to be that premature inferences must not be made from studies employing precipitation methods for the estimation of serum H.D.L.-cholesterol in diabetes mellitus--especially if other factors influencing serum H.D.L.-cholesterol levels are ignored. A further consideration stems from the finding that insulin-requiring diabetics may be abnormal in the distribution of the H.D.L.1, H.D.L.2 and H.D.L.3 sub-classes which make up total H.D.L.14 H.D.L.2 is considered by some to be the subfraction of H.D.L. reducing the risk of ischasmic heart-disease.15 Measurements of total serum H.D.L.-cholesterol in diabetes are therefore likely to be misleading, if the relationship between H.D.L.2 cholesterol and total H.D.L. cholesterol differs from normal. Futher studies in diabetes should concentrate on ultracentrifugation methods, which are the least likely to add more confusion to an already confused, but, quite probably, important area of medicine. Department of Medicine, Royal Infirmary, Manchester M13 9WL
PAUL DURRINGTON
PITUITARY HORMONES IN DIABETIC KETOACIDOSIS stress the importance of hormones in the of diabetic ketoacidevelopment pituitary dosis. In 1976 we reported a case2 which would emphasise this. A 14-year-old insulin-dependent diabetic female had diabetic ketoacidosis precipitated by a right-lower-lobe pneumonia. 3 years later she was again admitted in typical diabetic ketoacidosis, although on this occasion no obvious cause was found. When 29 years old she underwent local irradiation of the pituitary gland with yttrium-90 for advanced proliferative diabetic retinopathy. 10 months after this procedure she was admitted in severe non-ketotic hyperosmolar coma precipitated by a j3-haemo!ytic streptococcal tonsillitis. This was the second, reported instance of non-ketotic coma in a diabetic after pituitary ablation, the first being described by Kolodny and Sherman in 1968.3 Thus, in clinical practice, after pituitary abla-
SIR,-Dr Barnes and colleagues’
Yano, K., Rhoads, G.G., Kagan, A. New Engl. J. Med 1977, 297, 405.
Johansson, B. G., Nilsson-Ehle, P. ibid, 1977, 298, 633. Carlson, L. A., Ericsson, M. Atherosclerosis, 1975, 21, 417. Gordon, T., Kannel, W. B. Clins. Endocr. Metab. 1976, 5, 367. Fuller, J. H., Jarrett, R. J., Keen, H.; Pinney, S. L. Lancet, 1975, i, 691. 7. Fuller, J. H., Ruskin, H., Jarrett, R. J., Keen, H. Clin Sci mol Med. 1978, 55, 13P. 8. Ewing, A. M., Freeman, N. K., Lindgren, F. T. Adv. Lipid Res. 1965, 3, 25 9. Garrison, R. J., and others. Atherosclerosis, 1978, 30, 17. 10. Paisey, R., Elkeles, R. S., Hambley, J., Magill, P. Clin. Sci. mol. Med 1978, 54, 37P. 11. Lopes-Virella, M. F. L., Stone, P. G., Colwell, J. A. Diabetologia, 1977, 13, 3.
4. 5. 6.
285.
12. 13.
Durrington, P. N., and others. Clinica chim. Acta, 1976, 71, 95. Gotto, A. M, Miller, N. E., Oliver, M. F. (editors) High Density Lipoprotems and Atherosclerosis. Amsterdam, 1978. 14. Gofman, J. W., and others. Plasma, 1954, 2, 413. 15. Anderson, D. W., Nichols, A. V., Pan, S. S., Lindgren, F. T. Atherosclerosis, 1978, 29, 161. 1. Barnes, A. J., Kohner, E. M., Bloom, S. R., Johnston, D. G., Alberti, K. G. M. M., Smythe, P. Lancet, 1978, i, 1171. 2. Campbell, I. W., Munro, J. F., Duncan, L. J. P. Br. J. clin. Pract. 1976, 30, 49.
3 Kolodny,
H.
D., Sherman, L.J. Am. med. Ass. 1968, 203, 119.
A similar practice has been recommended by others.6 However, with our latest data on invasive tumour growth we believe that an infertile man should be advised to have a testis with carcinoma-in-situ removed as soon as the diagnosis has been made. Some germ:ell carcinomas are very malignant. Pugh and Cameron9 found a three-year corrected survival-rate of 47% in teratoma pa-
including palpation
ing on the back of the throat. Though Smith was subsequently hanged, he probably deserves some posthumous recognition for this use of the naso-trigemino- vagal reflex. Clinical School, Royal Prince Alfred Hospital, Camperdown, N.S.W., Australia.
PETER ROOT
orchidometry.
CEREBRAL INFARCTION AND MYOCARDIAL INFARCTION
SIR,-I agree with you’ that insufficient attention has been
SiR,—J can confirm that mouth-to-mouth breathing can be lifesaving in acute epiglottitis. io A boy aged 20 months with acute epiglottitis ceased breathing in my presence. The
to the profound differences in epidemiological characteristics between myocardial infarction and cerebral infarction. However, I was surprised to see that you base this opinion to a large extent on changes in routine mortality statistics. For cerebral infarction such statistics are hopelessly compromised by changing terminology and by the widespread (but variable) use of non-specific terms such as stroke and cerebrovascular accident. Detailed study of original death certificates and necropsy records reveals that there has been virtually no change in the death-rate from cerebrovascular disease since 1901, and that both the sex ratio and the relative contribution of cerebral infarction have also been remarkably stable.2 By contrast, the male (but not the female) death-rate from myocardial infarction has increased greatly since the early
obstruction was so severe that it prevented both inspiration and expiration. After I had inflated the lungs by mouth-tomouth breathing, I had to compress the chest to expel the air again. An interesting feature was that when an oxygen mask was used the boy then had the strength to breathe spontaneously, but breathing failed again when the mask was removed. He reached hospital alive and was successfully treated by intubation followed by tracheostomy. A throat swab
The anomalous behaviour of the male death-rate from myocardial infarction is clearly seen in the accompanying figure. In the census year of 1921 male and female death rates showed similar age-specific slopes for both ischaamic heart-disease and total cerebrovascular disease. Fifty years later, in 1971, there had been very little change except in the male heart-disease rates, which had increased several-fold, especially at younger
yielded group-A haemolytic streptococci.
ages. These observations do
tients. Laboratory of Reproductive Biology and Fertility Clinic, Department of Obstetrics and Gynæcology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
NIELS E. SKAKKEBÆK JØRGEN G. BERTHELSEN
ACUTE EPIGLOTTITIS
71 Victoria Road, Oulton Broad, Lowestoft NR33 9LW
N. B. EASTWOOD
DANGEROUS NASAL REFLEXES
paid
1920s.3-6
not
necessarily challenge,
as
your edi-
1. 2.
Lancet, 1978, i, 1239. Anderson, T. W., MacKay, J. S. ibid, 1968, i, 1137. 3. Anderson, T. W., le Riche, W. H. Br. J. prev. soc. Med., 1970, 24, 1. 4. Anderson, T. W. Can. med.Ass.J. 1973,108, 1500. 5. Anderson, T. W. Lancet, 1973, ii, 298. 6. Anderson, T. W. New Scientist, 1978, 77, 374.
reflexes from the nose"I calls to mind the case of the murderer George Joseph Smith. 12 A polygamist who made off with his brides’ savings within days of marriage, Smith in 1910 married a Beatrice Munday whose considerable private means he soon discovered were in the hands of trustees. On July 9, 1911, having prevailed upon his "wife" to make out her will in his favour, he bought a cheap iron bathtub for their home and then visited a local doctor for a prescription for his wife’s "fits". Three visits by the doctor found the doomed lady complaining of no more than headache, nevertheless on July 13 he was summoned to find her lying supine and dead in the bathwater after a "fit". Fifteen months later another "wife" was found in identical circumstances in his Blackpool domestic bathtub. Overconfident now, his next wife died in her bath in London a mere three weeks later. The second victim’s father, still mourning, noticed the report in a newspaper and contacted the police. By June, 1915, Smith was on trial. Sir Bernard Spilsbury, for the prosecution, was able to demonstrate (having almost killed a policeman’s daughter who volunteered to be a guineapig) that if the legs of a person lying in a bath were suddenly jerked upwards, the resultant immersion of the head could cause a cardiac arrest, which he attributed to the pressure of water suddenly imping-
SIR,-Allison’s letter
8. 9.
on
dangerous
Hill, A. B. A Short Textbook of Medical Statistics. London, 1977 Pugh, R. C. B., Cameron, K. M. in Pathology of the Testis (edited by R. C. B. Pugh); p. 199. Oxford, 1976.
10. Lancet, 1978,i, 1294. 11. Allison, D J. Lancet, 1977, i, 909. 12. Camps, F. E Barber, R. The Investigation of Murder;
p. 78. London, 1966.
Age-specific death rates from cerebrovascular and isehsemic heart-disease, England and Wales, 1921 and 1971. Vertical scale is logarithmic, and horizontal (age) scale for cerebrovascular disease is shifted to right to avoid overlapping of lines.
206 torial suggests, the concept that cerebral infarction and myocardial infarction share a similar underlying xtiology (atherosclerosis). Rather, they challenge the simplistic idea that both are the automatic end-result of a single pathological process. This is particularly true in the case of the modern male epidemic of myocardial infarction, a large part of which could well be the result of an increase in the vulnerability of the myocardium to an inadequate blood-supply rather than a change in the prevalence of disease of the coronary arteries. Department of Preventive Medicine and Biostatistics,
University of Toronto, Toronto, Canada M5S 1A8
TERENCE W. ANDERSON
H.D.L. CHOLESTEROL IN DIABETES MELLITUS
SiR,—Iwas unable
to
agree with all the conclusions of Dr
Calvert and his
colleagues (July 8, p. 66). Before differences serum-high-density-lipoprotein (H.D.L.) cholesterol concen-
in trations in diabetic and normal men and women can be attributed to the diabetes per se, other factors which influence serum H.D.L.-cholesterol concentration and which may differ between different populations must be taken into account. Alcohol intake,I-3 for example, is likely to vary between diabetics who are on carbohydrate-restricted diets and normal controls, especially when these are recruited from the Armed Forces where heavy drinking is traditional. Calvert et al. provide information about body-weight, but it is not body-weight, but obesity which influences serum H.D.L.-cholesterol.4 Thus, weight should have been expressed as body-mass index or percentage of ideal weight so that allowance for height was made.5 The concentrations of serum cholesterol6,7 and triglycerides8 and number of cigarettes smoked,9 all of which influence serum H.D.L.-cholesterol levels, were not included in the paper. The conclusion that sulphonylureas might influence serum-H.D.L. cholesterol is not justified by the study since the groups receiving different therapies were matched only for age, weight, and HbA,. Indeed, the matching for weight does not seem to have been very precise since the S.E.M. for the weight of the sulphonylurea-treated group was very different from that of the other two groups. There was no matching for height, alcohol intake, or serum-lipid concentrations. Perhaps even more important, the treatment which patients were receiving had not been chosen at random, but presumably on the basis of clinical indications. Thus, the patients in each group did not differ solely in their treatment, but also in the degree and type of their diabetes. In another study in which the effect of starting treatment with chlorpropamide was examined there was an increase in serum H.D.L.-cholesterol concentration sustained over one year. 10 In the report by Lopes-Virella and othersl’ cited by Calvert and co-workers, it was concluded that patients with diabetes have lower than normal serum H.D.L.-cholesterol levels. However, their normal controls were unusual in that the distribution of their serum H.D.L.-cholesterol concentrations was positively skewed, despite which Student’s t test was used to compare them with diabetics. I have lately completed a study in which diabetic patients treated with insulin were found to have higher serum H.D.L.1. 2.
Castelli, W. P., and others. Lancet, 1977,
ii,
153.
cholesterol concentrations than normal men and women or diabetics not receiving insulin. The results are still being analysed but differences of the kind which I have discussed are emerging. Non-insulin-dependent diabetics are the most obese and have higher serum M-particle concentrations than the other two groups. They also have the lowest alcohol consumption, the normal group drinking the most alcohol. The heparin-MnCl2 method for estimating serum H.D.L.cholesterol was used in my study. This method gives higher H.D.L.-cholesterol levels than the phosphotungstate-MgCl2 method used by Calvert et al. and Lopes-Virella et al. This is probably because some H.D.L. is precipitated in the phosphotungstate-MgCl2 method, whereas with the heparin-MnCl2 method there may be some incomplete precipitation of H.D.L., and the apolipoprotein-B-containing lipoproteins. In my study the apolipoprotein-B concentration of the supernatants was determined by radioimmunoassay’2 and incomplete precipitation was not found to explain the differences in serum H.D.L.cholesterol observed. Fuller et al.’ found that serum H.D.L.cholesterol levels were highest in those non-diabetic local-government employees with the highest blood-glucose levels and Nikkila has recently reported results in diabetics similar to mine." At present, the most appropriate conclusion from all these studies seems to be that premature inferences must not be made from studies employing precipitation methods for the estimation of serum H.D.L.-cholesterol in diabetes mellitus--especially if other factors influencing serum H.D.L.-cholesterol levels are ignored. A further consideration stems from the finding that insulin-requiring diabetics may be abnormal in the distribution of the H.D.L.1, H.D.L.2 and H.D.L.3 sub-classes which make up total H.D.L.14 H.D.L.2 is considered by some to be the subfraction of H.D.L. reducing the risk of ischasmic heart-disease.15 Measurements of total serum H.D.L.-cholesterol in diabetes are therefore likely to be misleading, if the relationship between H.D.L.2 cholesterol and total H.D.L. cholesterol differs from normal. Futher studies in diabetes should concentrate on ultracentrifugation methods, which are the least likely to add more confusion to an already confused, but, quite probably, important area of medicine. Department of Medicine, Royal Infirmary, Manchester M13 9WL
PAUL DURRINGTON
PITUITARY HORMONES IN DIABETIC KETOACIDOSIS stress the importance of hormones in the of diabetic ketoacidevelopment pituitary dosis. In 1976 we reported a case2 which would emphasise this. A 14-year-old insulin-dependent diabetic female had diabetic ketoacidosis precipitated by a right-lower-lobe pneumonia. 3 years later she was again admitted in typical diabetic ketoacidosis, although on this occasion no obvious cause was found. When 29 years old she underwent local irradiation of the pituitary gland with yttrium-90 for advanced proliferative diabetic retinopathy. 10 months after this procedure she was admitted in severe non-ketotic hyperosmolar coma precipitated by a j3-haemo!ytic streptococcal tonsillitis. This was the second, reported instance of non-ketotic coma in a diabetic after pituitary ablation, the first being described by Kolodny and Sherman in 1968.3 Thus, in clinical practice, after pituitary abla-
SIR,-Dr Barnes and colleagues’
Yano, K., Rhoads, G.G., Kagan, A. New Engl. J. Med 1977, 297, 405.
Johansson, B. G., Nilsson-Ehle, P. ibid, 1977, 298, 633. Carlson, L. A., Ericsson, M. Atherosclerosis, 1975, 21, 417. Gordon, T., Kannel, W. B. Clins. Endocr. Metab. 1976, 5, 367. Fuller, J. H., Jarrett, R. J., Keen, H.; Pinney, S. L. Lancet, 1975, i, 691. 7. Fuller, J. H., Ruskin, H., Jarrett, R. J., Keen, H. Clin Sci mol Med. 1978, 55, 13P. 8. Ewing, A. M., Freeman, N. K., Lindgren, F. T. Adv. Lipid Res. 1965, 3, 25 9. Garrison, R. J., and others. Atherosclerosis, 1978, 30, 17. 10. Paisey, R., Elkeles, R. S., Hambley, J., Magill, P. Clin. Sci. mol. Med 1978, 54, 37P. 11. Lopes-Virella, M. F. L., Stone, P. G., Colwell, J. A. Diabetologia, 1977, 13, 3.
4. 5. 6.
285.
12. 13.
Durrington, P. N., and others. Clinica chim. Acta, 1976, 71, 95. Gotto, A. M, Miller, N. E., Oliver, M. F. (editors) High Density Lipoprotems and Atherosclerosis. Amsterdam, 1978. 14. Gofman, J. W., and others. Plasma, 1954, 2, 413. 15. Anderson, D. W., Nichols, A. V., Pan, S. S., Lindgren, F. T. Atherosclerosis, 1978, 29, 161. 1. Barnes, A. J., Kohner, E. M., Bloom, S. R., Johnston, D. G., Alberti, K. G. M. M., Smythe, P. Lancet, 1978, i, 1171. 2. Campbell, I. W., Munro, J. F., Duncan, L. J. P. Br. J. clin. Pract. 1976, 30, 49.
3 Kolodny,
H.
D., Sherman, L.J. Am. med. Ass. 1968, 203, 119.
